Healthcare Provider Details

I. General information

NPI: 1245219484
Provider Name (Legal Business Name): FRANCIS A DYSARZ III M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 BELLEVUE AVE STE 110
SAINT LOUIS MO
63117
US

IV. Provider business mailing address

1035 BELLEVUE AVE STE 110
SAINT LOUIS MO
63117-1847
US

V. Phone/Fax

Practice location:
  • Phone: 314-644-5150
  • Fax: 314-644-5156
Mailing address:
  • Phone: 314-644-5151
  • Fax: 314-644-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number119584
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: