Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | WV1480 | WV |
Y | 2081P2900X | Pain Medicine | WV1480 | WV |
NPI | 1013996503 |
---|---|
Provider Name | Philip Flint Fisher |
First Address | Barboursville, WV 25504 |
Second Address | South Point, OH 45680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2006 |
Last Update Date | 21/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001706518 | BLUE CROSS BLUE SHIELD (01) | |
5922061 | AETNA (01) | |
7728465001 | CIGNA (01) | |
F55190 | (02) | |
FI0786325 | PTAN (01) | WV |