Provider Demographics
NPI:1851063176
Name:FISHER, ZACHARY DOUGLAS (PA-C)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DOUGLAS
Last Name:FISHER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:UT
Mailing Address - Zip Code:84725-1121
Mailing Address - Country:US
Mailing Address - Phone:435-669-6168
Mailing Address - Fax:
Practice Address - Street 1:257 S 625 E
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:UT
Practice Address - Zip Code:84725
Practice Address - Country:US
Practice Address - Phone:435-669-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12451849-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant