Provider Demographics
NPI:1447559893
Name:MARLOW FISHER, STACEY MARIE (MD, JD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:MARIE
Last Name:MARLOW FISHER
Suffix:
Gender:F
Credentials:MD, JD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:MARIE
Other - Last Name:MARLOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, JD
Mailing Address - Street 1:1825 LOGAN AVE
Mailing Address - Street 2:EMERGENCY DEPARTMENT, ALLEN MEMORIAL HOSPITAL
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1916
Mailing Address - Country:US
Mailing Address - Phone:319-235-3697
Mailing Address - Fax:
Practice Address - Street 1:1825 LOGAN AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT, ALLEN MEMORIAL HOSPITAL
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1916
Practice Address - Country:US
Practice Address - Phone:319-235-3697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2015-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114051207P00000X
IA40597207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HO036ZMedicare PIN