Provider Demographics
NPI:1265622468
Name:FISH, ALYSON MICHELE (MD)
Entity type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:MICHELE
Last Name:FISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-0177
Mailing Address - Country:US
Mailing Address - Phone:501-679-3998
Mailing Address - Fax:501-708-2538
Practice Address - Street 1:25 BUSINESS PARK
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9475
Practice Address - Country:US
Practice Address - Phone:501-679-3998
Practice Address - Fax:501-708-2538
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167132001Medicaid
AR167132001Medicaid