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1760483101
PETER FONSECA
BRIDGETON, MO
NPI
1760483101
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery)
(Licence: MO 116658)
Enumeration Date
2005-08-09
Last Update Date
2020-11-05
Business Address
Dr. PETER FONSECA M.D.
12266 DE PAUL DR STE 205
BRIDGETON, MO 63044-2514
Phone number: 314-647-8269
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Mailing Address
Dr. PETER FONSECA M.D.
PO BOX 955534
SAINT LOUIS, MO 63195-5534
Phone number:
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