1578746244 NPI number — EDWARD H FISHER III M.D., P.C.

Table of content: (NPI 1578746244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578746244 NPI number — EDWARD H FISHER III M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD H FISHER III M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1578746244
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 759
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35653-0759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-332-1800
Provider Business Mailing Address Fax Number:
256-332-1815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
715 GANDY ST NE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
RUSSELLVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35653-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-332-1800
Provider Business Practice Location Address Fax Number:
256-332-1815
Provider Enumeration Date:
12/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DR
Authorized Official Telephone Number:
256-332-1800

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD 18628 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com