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Individual

EVAN E. FUSCO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
100 HOSPITAL DR, LEBANON, MO 65536-9210
(417) 533-6100
(417) 533-6021
Mailing address
PO BOX 504274, SAINT LOUIS, MO 63150-4274
(417) 829-4620
(417) 829-4316

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2000160755
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1043323660
MO
05
206863904
MO
Enumeration date
08/16/2006
Last updated
06/02/2015
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