Healthcare Provider Details

I. General information

NPI: 1952379224
Provider Name (Legal Business Name): WILLIAM JOHN MORICONI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12700 SOUTHFORK RD STE.125
SAINT LOUIS MO
63128-3201
US

IV. Provider business mailing address

12700 SOUTHFORK RD STE.125
SAINT LOUIS MO
63128-3201
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-6472
  • Fax: 314-842-5921
Mailing address:
  • Phone: 314-842-6472
  • Fax: 314-842-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberRIB83
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: