Provider Demographics
NPI:1376615054
Name:FISCHER, MARY ALLISON (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALLISON
Last Name:FISCHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1123 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-6103
Mailing Address - Country:US
Mailing Address - Phone:660-826-2797
Mailing Address - Fax:660-826-2365
Practice Address - Street 1:1123 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-6103
Practice Address - Country:US
Practice Address - Phone:660-826-2797
Practice Address - Fax:660-826-2365
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5C49207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
15322OtherALLIANCE
C52251OtherMERCY HEALTH PLANS
MO13753027OtherBLUECROSS
107921OtherHEALTHLINK
107921OtherHEALTHLINK
15322OtherALLIANCE