Provider Demographics
NPI:1245381201
Name:VERZOLA, EDWARDO DURANTE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARDO
Middle Name:DURANTE
Last Name:VERZOLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:1004 INDUSTRIAL DRIVE
Mailing Address - City:HERCULANEUM
Mailing Address - State:MO
Mailing Address - Zip Code:63048-0127
Mailing Address - Country:US
Mailing Address - Phone:636-937-8675
Mailing Address - Fax:636-933-1981
Practice Address - Street 1:1400 US HIGHWAY 61
Practice Address - Street 2:SUITE 250
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4100
Practice Address - Country:US
Practice Address - Phone:636-937-8675
Practice Address - Fax:636-933-7981
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-08-06
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Provider Licenses
StateLicense IDTaxonomies
MO2000161966207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH24579Medicare UPIN
MO000094938Medicare ID - Type Unspecified