Basic Information
| Provider Information | |||||||||
| NPI: | 1578650362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESPIRITU | ||||||||
| FirstName: | JOSEPH ROLAND | ||||||||
| MiddleName: | DIANO | ||||||||
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| Credential: | MD, MSPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3691 RUTGER ST. | ||||||||
| Address2: | PROVIDER ENROLLMENT | ||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149776828 | ||||||||
| FaxNumber: | 3149776777 | ||||||||
| Practice Location | |||||||||
| Address1: | 3660 VISTA | ||||||||
| Address2: | |||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145778856 | ||||||||
| FaxNumber: | 3145778859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 02/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | 103185 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | 103185 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 103185 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 036091620 | 05 | IL | MEDICAID | 207217605 | 05 | MO | MEDICAID |