Individual
MICHAEL R FANCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-4056
(417) 269-5556
Mailing address
1550 E REPUBLIC RD, SPRINGFIELD, MO 65804-6530
(417) 889-6102
(417) 889-6289
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R8G08
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1256
BLUE
MO
05
—
160278001
—
AR
05
—
203056072
—
MO
01
—
300120714
RRR MEDICARE
MO
Enumeration date
03/27/2006
Last updated
09/04/2009
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