Provider Demographics
NPI:1487661500
Name:FISHER, SARAH JANE ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JANE ELIZABETH
Last Name:FISHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JANE ELIZABETH
Other - Last Name:GOUY-FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:520 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1038
Mailing Address - Country:US
Mailing Address - Phone:812-885-3228
Mailing Address - Fax:812-885-3089
Practice Address - Street 1:520 S 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1038
Practice Address - Country:US
Practice Address - Phone:812-885-3228
Practice Address - Fax:812-885-3089
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006565A2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI152230OtherGREAT LAKES HEALTH PLAN
MI4803229Medicaid
MISG008555OtherBLUE CROSS BLUE SHIELD
MIU91110Medicare UPIN
MI0N23370008Medicare ID - Type UnspecifiedMEDICARE