Provider Demographics
NPI:1073916920
Name:FISHER, JOHN JULIAN (HISIT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JULIAN
Last Name:FISHER
Suffix:
Gender:M
Credentials:HISIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 N BUSINESS ROUTE 5
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-2642
Mailing Address - Country:US
Mailing Address - Phone:573-346-4500
Mailing Address - Fax:573-346-0480
Practice Address - Street 1:648 N BUSINESS ROUTE 5
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-2642
Practice Address - Country:US
Practice Address - Phone:573-346-4500
Practice Address - Fax:573-346-0480
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOHISIT2014001307237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1003037870Medicare PIN