Provider Demographics
NPI:1134249808
Name:FISHINGHAWK, BOBBI GENEVIEVE (MD)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:GENEVIEVE
Last Name:FISHINGHAWK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1401 W LOCUST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3276
Mailing Address - Country:US
Mailing Address - Phone:918-696-4065
Mailing Address - Fax:918-696-5971
Practice Address - Street 1:1401 W LOCUST ST STE 102
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960
Practice Address - Country:US
Practice Address - Phone:918-696-4065
Practice Address - Fax:918-696-5971
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28803208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200394210AMedicaid