Provider Demographics
NPI:1861481558
Name:ANZALONE, JOHN FRANK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANK
Last Name:ANZALONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 E TERRA LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2750
Mailing Address - Country:US
Mailing Address - Phone:636-272-6161
Mailing Address - Fax:
Practice Address - Street 1:1055 E TERRA LN
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2750
Practice Address - Country:US
Practice Address - Phone:636-272-6161
Practice Address - Fax:636-240-9188
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7830208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO240294009Medicaid
MO240294009Medicaid
6669Medicare ID - Type Unspecified