Basic Information
| Provider Information | |||||||||
| NPI: | 1225391824 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHMAN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O., M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3015 N BALLAS RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149965772 | ||||||||
| FaxNumber: | 3149967691 | ||||||||
| Practice Location | |||||||||
| Address1: | 3015 N BALLAS RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149965772 | ||||||||
| FaxNumber: | 3149967691 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2012 | ||||||||
| LastUpdateDate: | 02/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2015043478 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 2015043478 | MO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.