Provider Demographics
NPI:1871757187
Name:FISHER, GEORGE RAWLEIGH (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RAWLEIGH
Last Name:FISHER
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 WOLF CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2348
Mailing Address - Country:US
Mailing Address - Phone:337-478-0468
Mailing Address - Fax:337-478-3816
Practice Address - Street 1:1624 WOLF CIR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-478-0468
Practice Address - Fax:337-478-3816
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA54011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery