Provider Demographics
NPI:1063166106
Name:BOBBI G. FISHINGHAWK, MD, PLLC
Entity type:Organization
Organization Name:BOBBI G. FISHINGHAWK, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBI
Authorized Official - Middle Name:G
Authorized Official - Last Name:FISHINGHAWK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-669-5546
Mailing Address - Street 1:79549 S 4720 RD
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-5086
Mailing Address - Country:US
Mailing Address - Phone:913-669-5546
Mailing Address - Fax:
Practice Address - Street 1:8803 S 101ST EAST AVE STE 160
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5745
Practice Address - Country:US
Practice Address - Phone:918-294-4325
Practice Address - Fax:918-294-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty