Healthcare Provider Details

I. General information

NPI: 1043225527
Provider Name (Legal Business Name): HAL GREGORY FISER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N STATE ST SUITE 502
JACKSON MS
39202-2413
US

IV. Provider business mailing address

1190 N STATE ST SUITE 502
JACKSON MS
39202-2413
US

V. Phone/Fax

Practice location:
  • Phone: 601-944-1781
  • Fax: 601-353-0439
Mailing address:
  • Phone: 601-944-1781
  • Fax: 601-353-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number09108
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: