Provider Demographics
NPI:1568444750
Name:FISHER, CARY ARDIS (MD)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:ARDIS
Last Name:FISHER
Suffix:
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 1:7301 N COMANCHE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-6636
Mailing Address - Country:US
Mailing Address - Phone:405-728-2100
Mailing Address - Fax:405-728-2244
Practice Address - Street 1:7301 N COMANCHE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-6636
Practice Address - Country:US
Practice Address - Phone:405-728-2100
Practice Address - Fax:405-728-2244
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100085570AMedicaid
F26882Medicare UPIN
OK248321602Medicare ID - Type Unspecified