Provider Demographics
NPI:1386207702
Name:FISHER, ALEC HAYES
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:HAYES
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MASCOMA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-2638
Mailing Address - Country:US
Mailing Address - Phone:310-801-3309
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ RM 411
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-963-3985
Practice Address - Fax:856-365-7582
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program