Healthcare Provider Details

I. General information

NPI: 1508284738
Provider Name (Legal Business Name): ALEXANDER VERNON FISHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STATE ST STE 330
BANGOR ME
04401-6638
US

IV. Provider business mailing address

43 WHITING HILL RD STE 300
BREWER ME
04412-1006
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-8881
  • Fax: 207-973-8880
Mailing address:
  • Phone: 79-735-0352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number2021-01510
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD26980
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: