Provider Demographics
NPI:1225197718
Name:FISHER, JON SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:SCOTT
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1277 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JAMISON
Mailing Address - State:PA
Mailing Address - Zip Code:18929-1189
Mailing Address - Country:US
Mailing Address - Phone:215-491-9077
Mailing Address - Fax:215-491-2029
Practice Address - Street 1:157 BUSTLETON PIKE # 161
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6456
Practice Address - Country:US
Practice Address - Phone:215-322-0222
Practice Address - Fax:215-322-0442
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006224L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE 13906Medicare UPIN
PAFI 1524420Medicare ID - Type Unspecified