Provider Demographics
NPI:1104002302
Name:RONALD L. FISCHER, MD
Entity Type:Organization
Organization Name:RONALD L. FISCHER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-878-7630
Mailing Address - Street 1:226 S WOODS MILL RD
Mailing Address - Street 2:59W
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3662
Mailing Address - Country:US
Mailing Address - Phone:314-878-7630
Mailing Address - Fax:314-434-8457
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:59W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-878-7630
Practice Address - Fax:314-434-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6J45208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE15348Medicare UPIN