Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35053972 | OH |
N | 207QS0010X | Family Doctor - Sports Medicine | 35053972 | OH |
NPI | 1184617409 |
---|---|
Provider Name | Barry A Fisher |
First Address | Columbus, OH 43271-1808 |
Second Address | Dayton, OH 45459-7010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 17/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0632659 | (05) | OH |
080152611 | MEDICARE RR (01) | OH |
A16558 | (02) | OH |