MEDICARE: DAVID L FISHER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	984	OK

General Provider Information

NPI Number	:	1518068501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L FISHER PA-C

Provider Business Mailing Address
First Line	:	610 E 24TH ST
Second Line	:
City	:	TISHOMINGO
State	:	OK
Zip	:	73460-3245
Country	:	US
Telephone Number	:	580-371-2343
Fax Number	:	580-371-2451

Provider Business Practice Location Address
First Line	:	1556 S VIRGINIA AVE
Second Line	:
City	:	ATOKA
State	:	OK
Zip	:	74525-3246
Country	:	US
Telephone Number	:	580-889-4746
Fax Number	:	580-889-4735

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	12/19/2022

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Directions to “ DAVID L FISHER PA-C” Practice Location

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