Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | R7780 | MO |
NPI | 1699869925 |
---|---|
Provider Name | Dr. Keith C Fischer |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 24/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202768412 | (05) | MO |
ENROLLED | (05) | IL |