Individual
DR. JACK MARK FISHAUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
235 BLAIR AVE, FRIDAY HARBOR, WA 98250-0796
(360) 370-5971
(360) 370-5980
Mailing address
PO BOX 796, FRIDAY HARBOR, WA 98250-0796
(360) 370-5971
(360) 370-5980
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00040965
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
361929500
PARK NATL L & L
—
01
—
4952FI
REGENCE BLUE SHIELD
—
01
—
532300004
GROUP HEALTH
—
01
—
8387367
DSHS MEDICAID
—
01
—
8930937
CRIME VICTIMS
—
01
—
912109329
UNIFORM
—
01
—
LABOR AND INDUSTRIES
0182789
—
Enumeration date
12/01/2005
Last updated
03/07/2023
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