Basic Information
| Provider Information | |||||||||
| NPI: | 1477523215 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | LAURIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 130 | ||||||||
| Address2: | |||||||||
| City: | RATCLIFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729510130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796355300 | ||||||||
| FaxNumber: | 4796352010 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 KELLEY HWY | ||||||||
| Address2: | |||||||||
| City: | FORT SMITH | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729045000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797855700 | ||||||||
| FaxNumber: | 4797855708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 09/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C5831 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 11759000000 | 01 | AR | QUALCHOICE | OTHER | 0062731 | 01 | AR | UMWA H&R FUNDS | OTHER | 1354042 | 01 | AR | UNITED HEALTHCARE | OTHER | 0790780001 | 01 | AR | PALMETTO GBA | OTHER | 020407900 | 01 | AR | BLACK LUNG PROGRAM | OTHER | 7294114 | 01 | AR | AETNA | OTHER | 080057403 | 01 | AR | RAILROAD MEDICARE/PALMETT | OTHER | 103108001 | 05 | AR | MEDICAID | 54965 | 01 | AR | BLUECROSSBLUESHIELD ARK | OTHER | XX12984 | 01 | AR | HEALTH PLUS OF MICHIGAN | OTHER | 341149 | 01 | AR | HEALTH LINK | OTHER |