Basic Information
| Provider Information | |||||||||
| NPI: | 1174556054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | HARRY | ||||||||
| MiddleName: | CHAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 W WRANGLER BLVD | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748681917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053034611 | ||||||||
| FaxNumber: | 4053034617 | ||||||||
| Practice Location | |||||||||
| Address1: | 919 JEFFERSON ST | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748681900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053820585 | ||||||||
| FaxNumber: | 4053825940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 3189 | OK | N | Allopathic & Osteopathic Physicians | Surgery | 207P00000X | 3189 | OK | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100114010B | 05 | OK | MEDICAID |