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General NPI Number Information
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NPI Number | 1174508436
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Entity Type | Individual
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Provider Name | VINCENT P. FORTUNATO MD
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Gender | Male
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 2325 DOUGHERTY FERRY RD STE 104
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City | SAINT LOUIS
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State | MO
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Zip | 63122-3356
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Country | US
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Telephone | 148-216-8893
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Fax | 314-821-1887
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Provider Business Mailing Address
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Address Line | 10004 KENNERLY RD SUITE #255A
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2141
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Country | US
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Telephone | 314-843-5140
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Fax | 314-843-8010
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | R1J64
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License Number State | MO
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