Individual
DOUGLAS FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.C.
Contact information
Practice address
117 HAMPTON RD, SOUTHAMPTON, NY 11968-4923
(631) 287-8600
(631) 204-1585
Mailing address
PO BOX 273, EAST MARION, NY 11939
(631) 287-8600
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
23-013281
NY
363AM0700X
Medical Physician Assistant
PA00256
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30584
BLUE SHIELD
RI
Enumeration date
06/21/2005
Last updated
03/07/2023
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