Provider Demographics
NPI:1578746244
Name:EDWARD H FISHER III M.D., P.C.
Entity Type:Organization
Organization Name:EDWARD H FISHER III M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:256-332-1800
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-0759
Mailing Address - Country:US
Mailing Address - Phone:256-332-1800
Mailing Address - Fax:256-332-1815
Practice Address - Street 1:715 GANDY ST NE
Practice Address - Street 2:SUITE B
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1922
Practice Address - Country:US
Practice Address - Phone:256-332-1800
Practice Address - Fax:256-332-1815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD 18628174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty