Individual
WILLIAM WYMAN FISKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
134 ANSEL HALLET RD, W YARMOUTH, MA 02673-2582
(508) 771-9779
Mailing address
134 ANSEL HALLET RD, W YARMOUTH, MA 02673-2582
(508) 771-9779
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
74240
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110095135A
—
MA
01
—
J11263
BLUE CROSS BLUE SHIELD
MA
01
—
P00429633
RR MEDICARE
MA
Enumeration date
06/06/2006
Last updated
05/22/2013
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