Healthcare Provider Details

I. General information

NPI: 1477523215
Provider Name (Legal Business Name): LAURIE FISHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 KELLEY HWY
FORT SMITH AR
72904-5000
US

IV. Provider business mailing address

PO BOX 130
RATCLIFF AR
72951-0130
US

V. Phone/Fax

Practice location:
  • Phone: 479-785-5700
  • Fax: 479-785-5708
Mailing address:
  • Phone: 479-635-5300
  • Fax: 479-635-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC5831
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: