Provider Demographics
NPI:1447404074
Name:FISHER, PIERRE JAMES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PIERRE
Middle Name:JAMES
Last Name:FISHER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N WABASH AVE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2696
Mailing Address - Country:US
Mailing Address - Phone:765-662-8303
Mailing Address - Fax:765-664-4623
Practice Address - Street 1:330 N WABASH AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2696
Practice Address - Country:US
Practice Address - Phone:765-662-8303
Practice Address - Fax:765-664-4523
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01017708A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND94720Medicare UPIN