Healthcare Provider Details

I. General information

NPI: 1932619772
Provider Name (Legal Business Name): EZEQUIEL RAMON BELLORIN FONT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 02/14/2025
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3691 RUTGER STREET SUITE 222
ST LOUIS MO
63110
US

IV. Provider business mailing address

1008 S. SPRING AVENUE SLUCARE ACADEMIC PAVILION, DIV. OF NEPHROL, ROOM 2503
SAINT LOUIS MO
63110-2539
US

V. Phone/Fax

Practice location:
  • Phone: 314-762-0089
  • Fax: 314-762-0098
Mailing address:
  • Phone: 314-977-2650
  • Fax: 314-771-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2017034328
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2019026883
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: