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General NPI Number Information
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NPI Number | 1811970171
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Entity Type | Individual
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Provider Name | JAY E FISHER MD
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Gender | Male
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 5793 W MAPLE RD STE 147
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-4478
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Country | US
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Telephone | 248-862-7221
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Fax | 248-970-2941
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Provider Business Mailing Address
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Address Line | 5777 W MAPLE RD SUITE 200
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City | WEST BLOOMFIELD
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State | MI
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Zip | 48322-2267
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Country | US
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Telephone | 248-932-9223
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Fax | 248-932-8641
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301059572
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License Number State | MI
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