Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2015-02102 | NC |
Y | 207QS0010X | Family Doctor - Sports Medicine | 2015-02102 | NC |
NPI | 1215256839 |
---|---|
Provider Name | Brent Edward Fisher |
First Address | Charlotte, NC 28260-2998 |
Second Address | Asheville, NC 28801-4811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2010 |
Last Update Date | 31/01/2022 |