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General NPI Number Information
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NPI Number | 1659491314
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Entity Type | Individual
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Provider Name | PETER JOSEPH DIPASCO MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 10050 KENNERLY RD STE 2500
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2195
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Country | US
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Telephone | 314-525-4440
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Fax | 314-525-4531
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Provider Business Mailing Address
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Address Line | 10050 KENNERLY RD STE 2500
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2195
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Country | US
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Telephone | 314-525-4440
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Fax | 314-525-4531
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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 | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 04-34718
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | ME 111387
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | 2020036303
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License Number State | MO
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