Provider Demographics
NPI:1053348375
Name:FISCHER, KEVIN ROBERT (PA-C)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ROBERT
Last Name:FISCHER
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:2022 EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-8376
Mailing Address - Country:US
Mailing Address - Phone:850-939-8295
Mailing Address - Fax:850-881-5145
Practice Address - Street 1:113 LIEMANIS AVE
Practice Address - Street 2:16TH MDG
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544
Practice Address - Country:US
Practice Address - Phone:850-881-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical