Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS023657L | PA |
NPI | 1003021734 |
---|---|
Provider Name | Dr. Gerald Lewis Fisher |
First Address | Johnstown, PA 15909-1029 |
Second Address | Johnstown, PA 15909-1029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009239800002 | (05) | PA |