Provider Demographics
NPI:1831225036
Name:FISHER, PATRICK W (DO)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:W
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 BUDINGER AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4137
Mailing Address - Country:US
Mailing Address - Phone:407-891-2940
Mailing Address - Fax:407-891-2941
Practice Address - Street 1:1330 BUDINGER AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4137
Practice Address - Country:US
Practice Address - Phone:407-891-2940
Practice Address - Fax:407-891-2941
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11595207RC0000X
OK5177207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4M0447061Medicare PIN