Provider Demographics
NPI:1073725602
Name:FIESTER, RICHARD FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FREDERICK
Last Name:FIESTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 HICKORYWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52411-8043
Mailing Address - Country:US
Mailing Address - Phone:319-395-9535
Mailing Address - Fax:319-395-9284
Practice Address - Street 1:5531 HICKORYWOOD CT
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52411-8043
Practice Address - Country:US
Practice Address - Phone:319-395-9535
Practice Address - Fax:319-395-9284
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20465207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20465OtherMED. LICENSE NUMBE
IA20465OtherMED. LICENSE NUMBE