Provider Demographics
NPI:1689014276
Name:CHEESMAN ROCCA, ANTONIO RICARDO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:RICARDO
Last Name:CHEESMAN ROCCA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1008 SOUTH GRAND BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1016
Mailing Address - Country:US
Mailing Address - Phone:314-977-2140
Mailing Address - Fax:314-977-1660
Practice Address - Street 1:1225 S GRAND BLVD FL 3
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-257-3760
Practice Address - Fax:314-257-3761
Is Sole Proprietor?:No
Enumeration Date:2013-06-27
Last Update Date:2021-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2020010662207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology