Healthcare Provider Details

I. General information

NPI: 1013167600
Provider Name (Legal Business Name): ROBERT M FISCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DE PAUL DR RADIOLOGY DEPT
BRIDGETON MO
63044-2512
US

IV. Provider business mailing address

PO BOX 1127
MARYLAND HEIGHTS MO
63043-0127
US

V. Phone/Fax

Practice location:
  • Phone: 314-770-9393
  • Fax: 314-770-9997
Mailing address:
  • Phone: 314-770-9393
  • Fax: 314-770-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number149681
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036169059
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2014006480
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: