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General NPI Number Information
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NPI Number | 1609874791
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Entity Type | Individual
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Provider Name | SEAN Q. FISK P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4 MEDICAL PARK
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City | FAIRHOPE
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State | AL
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Zip | 36532-1872
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Country | US
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Telephone | 251-928-2401
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Fax | 251-928-5099
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Provider Business Mailing Address
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Address Line | 18521 YACHT CLUB RD
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City | FOLEY
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State | AL
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Zip | 36535-4071
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Country | US
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Telephone | 251-928-2401
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Fax | 251-928-5099
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-292
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License Number State | AL
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