MEDICARE: DR. WILLIAM W FISH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R4C24	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MA4170078	OTHER	MO	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MDR4C24	OTHER	MO	STATE LICENSE

General Provider Information

NPI Number	:	1821090598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM W FISH M.D.

Provider Business Mailing Address
First Line	:	5301 FARAON ST
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-3512
Country	:	US
Telephone Number	:	816-271-7861
Fax Number	:

Provider Business Practice Location Address
First Line	:	9784 N ASH AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64157-9742
Country	:	US
Telephone Number	:	816-781-4244
Fax Number	:	816-781-3542

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/19/2018

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