Provider Demographics
NPI:1366699431
Name:WILLIAM DELBERT FISHER D.O., INC
Entity type:Organization
Organization Name:WILLIAM DELBERT FISHER D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-966-7668
Mailing Address - Street 1:100 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-4355
Mailing Address - Country:US
Mailing Address - Phone:765-966-7668
Mailing Address - Fax:765-966-8452
Practice Address - Street 1:100 N 15TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-4355
Practice Address - Country:US
Practice Address - Phone:765-966-7668
Practice Address - Fax:765-966-8452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000324A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100211510AMedicaid
IN000000143109OtherANTHEM
IN699030Medicare PIN
IN000000143109OtherANTHEM