Healthcare Provider Details

I. General information

NPI: 1003231853
Provider Name (Legal Business Name): NATHAN M FISHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2014
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12639 OLD TESSON RD STE 115
SAINT LOUIS MO
63128-2786
US

IV. Provider business mailing address

12639 OLD TESSON RD STE 115
SAINT LOUIS MO
63128-2786
US

V. Phone/Fax

Practice location:
  • Phone: 314-849-0311
  • Fax: 314-849-4423
Mailing address:
  • Phone: 314-849-0311
  • Fax: 314-849-4423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2020012910
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number2020012910
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: