Provider Demographics
NPI:1245219484
Name:DYSARZ, FRANCIS A III (M D)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:A
Last Name:DYSARZ
Suffix:III
Gender:M
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1035 BELLEVUE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1847
Mailing Address - Country:US
Mailing Address - Phone:314-644-5151
Mailing Address - Fax:314-644-5156
Practice Address - Street 1:1035 BELLEVUE AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117
Practice Address - Country:US
Practice Address - Phone:314-644-5150
Practice Address - Fax:314-644-5156
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119584208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO020042525OtherRAILROAD MEDICARE
MO19591OtherHEALTHCARE USA
MO122660OtherBLUE SHIELD
MO1703015OtherUHC
MO59709OtherGHP
MO999717OtherCOMMUNITY CARE PLUS
MO5039745OtherAETNA
MO204696009Medicaid
MO017240OtherFMH-EXCLUSIVE CHOICE
MO10297OtherESSENCE
MO8514118OtherCIGNA
MOG65935OtherMERCY
IL084976OtherHEALTH ALLIANCE
MO416712OtherHEALTHLINK
IL084976OtherHEALTH ALLIANCE
MO19591OtherHEALTHCARE USA