Individual
MR. GREGORY D FISK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
529 JASMINE ST, OMAK, WA 98841-9589
(509) 826-1600
(509) 826-3633
Mailing address
529 JASMINE ST, OMAK, WA 98841-9589
(509) 826-1600
(509) 826-3633
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60149531
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202201
L & Z
WA
05
—
8439796
—
WA
Enumeration date
12/27/2005
Last updated
04/20/2016
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