Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 2008003433 | MO |
NPI | 1053533919 |
---|---|
Provider Name | Dr. Sonjay Joseph Fonn |
First Address | Cape Girardeau, MO 63702-0614 |
Second Address | Cape Girardeau, MO 63703-4927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 04/08/2020 |