Individual
DR. JEFFREY L FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
2121 LAKE AVE., VA NORTHERN INDIANA HEALTH CARE SYSTEM, FORT WAYNE, IN 56805-5100
(260) 426-5431
(260) 460-1482
Mailing address
2121 LAKE AVE, VA NORTHERN INDIANA, FORT WAYNE, IN 56805-5100
(260) 426-5431
(260) 460-1482
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041565S
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200319750
—
IN
Enumeration date
09/02/2005
Last updated
03/25/2013
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