Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 35071927 | OH |
NPI | 1437154770 |
---|---|
Provider Name | Dr. Barry Jason Fish |
First Address | Fairlawn, OH 44333-3339 |
Second Address | Fairlawn, OH 44333-3339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2005 |
Last Update Date | 09/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10791435 | CAQH (01) | OH |
2140730 | (05) | OH |
H05825 | (02) | OH |