Individual
JACOB FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2701 13TH AVE S, FARGO, ND 58103-3602
(701) 234-3620
Mailing address
2701 13TH AVE S, FARGO, ND 58103-3602
(701) 234-3620
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
13230
ND
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/21/2011
Last updated
01/23/2015
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