Provider Demographics
NPI:1265475487
Name:FISHER, KAREN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 NELSON ROAD, BLDG. B, STE.5
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-474-5070
Mailing Address - Fax:337-475-4195
Practice Address - Street 1:4150 NELSON RD STE 9
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4148
Practice Address - Country:US
Practice Address - Phone:337-419-0900
Practice Address - Fax:337-602-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025619207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1043613Medicaid
LA4J831C423Medicare ID - Type Unspecified
LAI37924Medicare UPIN