Provider Demographics
NPI:1013996503
Name:FISHER, PHILIP FLINT (DO)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:FLINT
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 US RT 60 EAST
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-736-2981
Mailing Address - Fax:304-736-2985
Practice Address - Street 1:804-1/2 SOLIDA RD.
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680
Practice Address - Country:US
Practice Address - Phone:304-736-2981
Practice Address - Fax:304-736-2985
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV1480208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVFI0786325OtherPTAN
001706518OtherBLUE CROSS BLUE SHIELD
7728465001OtherCIGNA
5922061OtherAETNA
WVFI0786325OtherPTAN
WVFI0786325Medicare PIN
FI0786325Medicare ID - Type Unspecified