1477523215 NPI number — DR. LAURIE FISHER M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477523215 NPI number — DR. LAURIE FISHER M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

FISHER

Provider First Name:

LAURIE

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1477523215

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/15/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 130

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

RATCLIFF

Provider Business Mailing Address State Name:

AR

Provider Business Mailing Address Postal Code:

72951-0130

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

479-635-5300

Provider Business Mailing Address Fax Number:

479-635-2010

Provider First Line Business Practice Location Address:

4900 KELLEY HWY

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FORT SMITH

Provider Business Practice Location Address State Name:

AR

Provider Business Practice Location Address Postal Code:

72904-5000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

479-785-5700

Provider Business Practice Location Address Fax Number:

479-785-5708

Provider Enumeration Date:

01/24/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  C5831 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 11759000000 . This is a "QUALCHOICE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 0062731 . This is a "UMWA H&R FUNDS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 1354042 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 0790780001 . This is a "PALMETTO GBA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 020407900 . This is a "BLACK LUNG PROGRAM" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 7294114 . This is a "AETNA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 080057403 . This is a "RAILROAD MEDICARE/PALMETT" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 103108001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
• Identifier: 54965 . This is a "BLUECROSSBLUESHIELD ARK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: XX12984 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
• Identifier: 341149 . This is a "HEALTH LINK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".