Healthcare Provider Details

I. General information

NPI: 1578650362
Provider Name (Legal Business Name): JOSEPH ROLAND DIANO ESPIRITU MD, MSPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 VISTA
ST. LOUIS MO
63110
US

IV. Provider business mailing address

3691 RUTGER ST. PROVIDER ENROLLMENT
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-8856
  • Fax: 314-577-8859
Mailing address:
  • Phone: 314-977-6828
  • Fax: 314-977-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number103185
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number103185
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number103185
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: