Provider Demographics
NPI:1720722002
Name:FISHER, LAURA BURGHER (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:BURGHER
Last Name:FISHER
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 1:1590 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9431
Mailing Address - Country:US
Mailing Address - Phone:435-753-4016
Mailing Address - Fax:435-792-3101
Practice Address - Street 1:1590 CANYON RD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9431
Practice Address - Country:US
Practice Address - Phone:435-753-4016
Practice Address - Fax:435-792-3101
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT176880-12052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty