Provider Demographics
NPI:1124253398
Name:G B FISHER III DO PA
Entity type:Organization
Organization Name:G B FISHER III DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:BRIT
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:239-431-7070
Mailing Address - Street 1:875 105TH AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108
Mailing Address - Country:US
Mailing Address - Phone:239-431-7070
Mailing Address - Fax:239-431-7075
Practice Address - Street 1:875 105 AVE NORTH
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108
Practice Address - Country:US
Practice Address - Phone:239-431-7070
Practice Address - Fax:239-431-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7853207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49530OtherBLUE CROSS/BLUE SHIELD
FL256757100Medicaid
FL256757100Medicaid
FLG84565Medicare UPIN
FL4866360001Medicare NSC