Healthcare Provider Details

I. General information

NPI: 1568444750
Provider Name (Legal Business Name): CARY ARDIS FISHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N COMANCHE AVE SUITE B
WARR ACRES OK
73132-6636
US

IV. Provider business mailing address

7301 N COMANCHE AVE SUITE B
WARR ACRES OK
73132-6636
US

V. Phone/Fax

Practice location:
  • Phone: 405-728-2100
  • Fax: 405-728-2244
Mailing address:
  • Phone: 405-728-2100
  • Fax: 405-728-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17279
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: