Healthcare Provider Details

I. General information

NPI: 1831128735
Provider Name (Legal Business Name): DARRELL NEIL FISKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 SE OCEAN BLVD STE 101
STUART FL
34996-3301
US

IV. Provider business mailing address

2220 SE OCEAN BLVD STE 101
STUART FL
34996-3301
US

V. Phone/Fax

Practice location:
  • Phone: 772-283-8380
  • Fax: 772-283-5538
Mailing address:
  • Phone: 772-283-8380
  • Fax: 772-283-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberME61051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: