1689620635 NPI number — GENE FIORETTI M.D.

Table of content: ALFONSO BULSECO RPH (NPI 1356064174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689620635 NPI number — GENE FIORETTI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIORETTI
Provider First Name:
GENE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689620635
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 BARRON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POPLAR BLUFF
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63901-1908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-686-3937
Provider Business Mailing Address Fax Number:
573-686-3958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2360 KATY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POPLAR BLUFF
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63901-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-686-3937
Provider Business Practice Location Address Fax Number:
573-686-3958
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  119233 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 204647713 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1689620635 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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