Provider Demographics
NPI:1548470032
Name:FUENTES, FE POBLETE (MD)
Entity type:Individual
Prefix:
First Name:FE
Middle Name:POBLETE
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 GRASSO PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-3108
Mailing Address - Country:US
Mailing Address - Phone:314-638-9309
Mailing Address - Fax:314-638-9333
Practice Address - Street 1:84 GRASSO PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-3108
Practice Address - Country:US
Practice Address - Phone:314-638-9309
Practice Address - Fax:314-638-9333
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO35954207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201263464Medicaid
MO201263464Medicaid