Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | JF048109 | MI |
NPI | 1144238593 |
---|---|
Provider Name | Jefrey Ralph-Alan Fishman |
First Address | Troy, MI 48084 |
Second Address | Troy, MI 48084 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F01721 | (02) |