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General NPI Number Information
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NPI Number | 1659362929
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Entity Type | Individual
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Provider Name | GRAEME DONALD FISHER M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 4117 VETERANS MEMORIAL DRIVE
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City | MOUNT VERNON
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State | IL
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Zip | 62864
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Country | US
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Telephone | 618-241-7016
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Fax |
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Provider Business Mailing Address
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Address Line | 6 SANDY RIDGE RD
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City | STERLING
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State | MA
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Zip | 01564-2362
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Country | US
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Telephone | 978-422-9646
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Fax |
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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 | 2085R0203X
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Taxonomy Name | Therapeutic Radiology Physician
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License Number | 036-115830
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 152515
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | MD2025-0590
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License Number State | NM
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