Bonacorsi, John Joseph

Bonacorsi, John Joseph is an individual health care provider with primary practice located at 12277 De Paul Dr Ste. 502S, Bridgeton MO 63044-2516. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Bonacorsi, John Joseph can be contacted via phone (314) 291-5307.

Contact Information

Primary practice address
12277 De Paul Dr Ste. 502S Bridgeton MO 63044-2516
Phone: (314) 291-5307
Fax: (314) 291-0838
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X R5611 Missouri

Profile Details

NPI number 1265541395
LBN Legal business name Bonacorsi, John Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 30th, 2006
Last updated Sep 14th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265541395 NPPES
Missouri MEDICAID 200165504
Missouri Other 001013172

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