Peralta, Enrique

Peralta, Enrique is an individual health care provider with primary practice located at 11710 Old Ballas Rd Suite 102, Saint Louis MO 63141-7076. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Peralta, Enrique can be contacted via phone (314) 569-2020.

Contact Information

Primary practice address
11710 Old Ballas Rd Suite 102 Saint Louis MO 63141-7076
Phone: (314) 569-2020
Fax: (314) 569-1596
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 2004012770 Missouri
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 036-112111 Illinois

Profile Details

NPI number 1346237534
LBN Legal business name Peralta, Enrique
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 3rd, 2005
Last updated Feb 8th, 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 1346237534 NPPES
Missouri MEDICAID 209310200
Missouri MEDICAID 036112111

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