Provider Demographics
NPI:1134223449
Name:FISHER, WILLIAM DELBERT (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DELBERT
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 1:100 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4355
Mailing Address - Country:US
Mailing Address - Phone:765-966-7668
Mailing Address - Fax:765-966-8452
Practice Address - Street 1:100 N 15TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4355
Practice Address - Country:US
Practice Address - Phone:765-966-7668
Practice Address - Fax:765-966-8452
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000324A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000143109OtherANTHEM BLUE CROSS
IN100211510AMedicaid
IN351303123100Medicaid
IN000000143109OtherANTHEM BLUE CROSS
IN011568021Medicare ID - Type UnspecifiedRAILROAD MEDICARE
INC25448Medicare UPIN