Healthcare Provider Details

I. General information

NPI: 1093981946
Provider Name (Legal Business Name): RYAN THOMAS FISCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

2401 GILLHAM RD
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3016
  • Fax: 816-802-1465
Mailing address:
  • Phone: 816-234-3016
  • Fax: 816-802-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD430062
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number04-35879
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number25201
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code2080T0004X
TaxonomyPediatric Transplant Hepatology Physician
License Number04-35879
License Number StateKS
# 5
Primary TaxonomyY
Taxonomy Code2080T0004X
TaxonomyPediatric Transplant Hepatology Physician
License Number2012029914
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: