Provider Demographics
NPI:1255392098
Name:FISHER, STEPHEN T (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:T
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 1:700 N COLUMBUS ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1455
Mailing Address - Country:US
Mailing Address - Phone:419-468-7785
Mailing Address - Fax:
Practice Address - Street 1:1593 OLENTANGY RD
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-9762
Practice Address - Country:US
Practice Address - Phone:419-468-7785
Practice Address - Fax:419-468-7295
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004257208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0797679Medicaid
OHP01749399OtherRAILROAD MEDICARE - MHCPI
E76317Medicare UPIN
OHH473210Medicare PIN
OHP01749399OtherRAILROAD MEDICARE - MHCPI
OHE76317Medicare UPIN