1245219484 NPI number — FRANCIS A DYSARZ III M. D.

Table of content: FRANCIS A DYSARZ III M. D. (NPI 1245219484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245219484 NPI number — FRANCIS A DYSARZ III M. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DYSARZ
Provider First Name:
FRANCIS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
M. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245219484
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1035 BELLEVUE AVE STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63117-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-644-5151
Provider Business Mailing Address Fax Number:
314-644-5156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 BELLEVUE AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-644-5150
Provider Business Practice Location Address Fax Number:
314-644-5156
Provider Enumeration Date:
01/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  119584 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 020042525 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 19591 . This is a "HEALTHCARE USA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 122660 . This is a "BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1703015 . This is a "UHC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 59709 . This is a "GHP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 999717 . This is a "COMMUNITY CARE PLUS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5039745 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 204696009 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 017240 . This is a "FMH-EXCLUSIVE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 10297 . This is a "ESSENCE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 8514118 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: G65935 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 084976 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 416712 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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