1508896077 NPI number — DR. RONALD FISCHER M.D.

Table of content: DR. RONALD FISCHER M.D. (NPI 1508896077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508896077 NPI number — DR. RONALD FISCHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISCHER
Provider First Name:
RONALD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1508896077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 S WOODS MILL RD
Provider Second Line Business Mailing Address:
STE 570 S
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017-3513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-205-6898
Provider Business Mailing Address Fax Number:
314-434-8457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 S WOODS MILL RD
Provider Second Line Business Practice Location Address:
STE 570 S
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-205-6898
Provider Business Practice Location Address Fax Number:
314-434-8457
Provider Enumeration Date:
07/03/2006

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: 208100000X , with the licence number:  R6J45 , 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: 0004598747 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 138778 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 757749 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000000602384 . This is a "BLUE CROSS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 475249 . This is a "GROUP HEALTH PLAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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