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NPI Code Detail

MEDICARE: EVAN E. FUSCO MD

MEDICARE: EVAN E. FUSCO MD
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
1207P00000XEmergency Medicine Physician2000160755MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043323660
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN E. FUSCO MD
Provider Business Mailing Address
First Line : PO BOX 504274
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63150-4274
Country : US
Telephone Number : 417-829-4620
Fax Number : 417-829-4316
Provider Business Practice Location Address
First Line : 100 HOSPITAL DR
Second Line :
City : LEBANON
State : MO
Zip : 65536-9210
Country : US
Telephone Number : 417-533-6100
Fax Number : 417-533-6021
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2006
Last Update Date : 06/02/2015

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Directions to “ EVAN E. FUSCO MD” Practice Location

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