Provider Demographics
NPI:1619076361
Name:DEISHER, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:DEISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:319 S SILVER SPRINGS RD
Mailing Address - Street 2:STE C
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6311
Mailing Address - Country:US
Mailing Address - Phone:573-334-4263
Mailing Address - Fax:573-334-3699
Practice Address - Street 1:319 S SILVER SPRINGS RD
Practice Address - Street 2:STE C
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-6311
Practice Address - Country:US
Practice Address - Phone:573-334-4263
Practice Address - Fax:573-334-3699
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO108028208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207997016Medicaid
MO8872OtherBLUE CROSS BLUE SHIELD