Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 1916 | OR |
Y | 103TC0700X | Clinical Psychologist | 1916 | OR |
NPI | 1003105743 |
---|---|
Provider Name | Philip Andrew Fisher |
First Address | Eugene, OR 97401-3541 |
Second Address | Eugene, OR 97401-3541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 04/04/2011 |