Basic Information
| Provider Information | |||||||||
| NPI: | 1689014276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEESMAN ROCCA | ||||||||
| FirstName: | ANTONIO | ||||||||
| MiddleName: | RICARDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 SOUTH GRAND BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | ST. LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149772140 | ||||||||
| FaxNumber: | 3149771660 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 S GRAND BLVD FL 3 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631041016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142573760 | ||||||||
| FaxNumber: | 3142573761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2013 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 2020010662 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.