Provider Demographics
NPI:1144389339
Name:FISKE, ROBERT JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:FISKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 JUNE ST
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1516
Mailing Address - Country:US
Mailing Address - Phone:541-386-3626
Mailing Address - Fax:541-386-3775
Practice Address - Street 1:1021 JUNE ST
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1516
Practice Address - Country:US
Practice Address - Phone:541-386-3626
Practice Address - Fax:541-386-3775
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R115415Medicare PIN
P00087036Medicare PIN
ORR01218Medicare UPIN