Provider Demographics
NPI:1285846055
Name:FISHER, DION GRANT (MD)
Entity Type:Individual
Prefix:DR
First Name:DION
Middle Name:GRANT
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-298-3893
Mailing Address - Fax:314-851-4408
Practice Address - Street 1:12277 DE PAUL DR
Practice Address - Street 2:SUITE 504
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2516
Practice Address - Country:US
Practice Address - Phone:314-298-3893
Practice Address - Fax:314-851-4408
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2007010564207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO124510007Medicare PIN