Provider Demographics
NPI:1609847250
Name:FISHER, EARL ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:ELLIOTT
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 1:218 WILD OAK DR
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-7902
Mailing Address - Country:US
Mailing Address - Phone:910-326-2947
Mailing Address - Fax:
Practice Address - Street 1:3280C HENDERSON DR
Practice Address - Street 2:NAVY FAMILY MEDICINE CLINIC
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5250
Practice Address - Country:US
Practice Address - Phone:910-455-1457
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14186208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics