Provider Demographics
NPI:1578650362
Name:ESPIRITU, JOSEPH ROLAND DIANO (MD, MSPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH ROLAND
Middle Name:DIANO
Last Name:ESPIRITU
Suffix:
Gender:M
Credentials:MD, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3691 RUTGER ST.
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-977-6828
Mailing Address - Fax:314-977-6777
Practice Address - Street 1:3660 VISTA
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-577-8856
Practice Address - Fax:314-577-8859
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO103185207RS0012X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091620Medicaid
MO207217605Medicaid
G29433Medicare UPIN
MO207217605Medicaid