Provider Demographics
NPI:1477523215
Name:FISHER, LAURIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951-0130
Mailing Address - Country:US
Mailing Address - Phone:479-635-5300
Mailing Address - Fax:479-635-2010
Practice Address - Street 1:4900 KELLEY HWY
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-5000
Practice Address - Country:US
Practice Address - Phone:479-785-5700
Practice Address - Fax:479-785-5708
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5831207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR11759000000OtherQUALCHOICE
AR0062731OtherUMWA H&R FUNDS
AR1354042OtherUNITED HEALTHCARE
AR0790780001OtherPALMETTO GBA
AR020407900OtherBLACK LUNG PROGRAM
AR7294114OtherAETNA
AR080057403OtherRAILROAD MEDICARE/PALMETT
AR103108001Medicaid
AR54965OtherBLUECROSSBLUESHIELD ARK
ARXX12984OtherHEALTH PLUS OF MICHIGAN
AR341149OtherHEALTH LINK
AR1354042OtherUNITED HEALTHCARE
AR103108001Medicaid