Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 042181 | NY |
NPI | 1013108943 |
---|---|
Provider Name | Dr. John Gary Fisher |
First Address | Hamburg, NY 14075-5835 |
Second Address | Hamburg, NY 14075-5835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2007 |
Last Update Date | 06/08/2007 |