Provider Demographics
NPI:1609874791
Name:FISK, SEAN Q (PA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:Q
Last Name:FISK
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:18521 YACHT CLUB RD
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-4071
Mailing Address - Country:US
Mailing Address - Phone:251-928-2401
Mailing Address - Fax:251-928-5099
Practice Address - Street 1:4 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1872
Practice Address - Country:US
Practice Address - Phone:251-928-2401
Practice Address - Fax:251-928-5099
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALPA-292363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P47854Medicare UPIN