Provider Demographics
NPI:1689620635
Name:FIORETTI, GENE (MD)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:
Last Name:FIORETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 BARRON RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-1908
Mailing Address - Country:US
Mailing Address - Phone:573-686-3937
Mailing Address - Fax:573-686-3958
Practice Address - Street 1:2360 KATY LN
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2300
Practice Address - Country:US
Practice Address - Phone:573-686-3937
Practice Address - Fax:573-686-3958
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119233207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204647713Medicaid
WY1689620635Medicaid
MO937824475Medicare UPIN
MO204647713Medicaid
WY1689620635Medicaid