Provider Demographics
NPI:1831128735
Name:FISKE, DARRELL NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:NEIL
Last Name:FISKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2220 SE OCEAN BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3301
Mailing Address - Country:US
Mailing Address - Phone:772-283-8380
Mailing Address - Fax:772-283-5538
Practice Address - Street 1:2220 SE OCEAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3301
Practice Address - Country:US
Practice Address - Phone:772-283-8380
Practice Address - Fax:772-283-5538
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2021-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME61051207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378032500Medicaid
FLG03501Medicare UPIN
FL26928Medicare ID - Type Unspecified