Dr Jack Mark Fishaut, MD is a
Pediatrics physician based in Friday Harbor, Washington. Dr Jack Mark Fishaut is licensed to practice in Washington (license number MD00040965) and his current practice location is 235 Blair Ave, Friday Harbor, Washington. He can be reached at his office (for appointments etc.) via phone at
(360) 370-5971.
NPI number for Dr Jack Mark Fishaut is 1891779195 and his current mailing address is Po Box 796, Friday Harbor, Washington. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1891779195.
Physician's Profile
| Full Name | Dr Jack Mark Fishaut |
|---|
| Gender | Male |
|---|
| Speciality | Pediatrics |
|---|
| Location | 235 Blair Ave, Friday Harbor, Washington |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1891779195
- Provider Enumeration Date: 12/01/2005
- Last Update Date: 03/07/2023
Medical Identifiers
Medical identifiers for Dr Jack Mark Fishaut such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1891779195 | NPI | - | NPPES |
| 361929500 | Other | | PARK NATL L & L |
| 532300004 | Other | | GROUP HEALTH |
| 4952FI | Other | | REGENCE BLUE SHIELD |
| 912109329 | Other | | UNIFORM |
| 912109329 | Other | | CHPW |
| 912109329 | Other | | PREMERA BLUE CROSS |
| LABOR AND INDUSTRIES | Other | | 0182789 |
| 8387367 | Other | | DSHS MEDICAID |
| 912109329 | Other | | FIRST CHOICE |
| 8930937 | Other | | CRIME VICTIMS |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 208000000X | Pediatrics | MD00040965 (Washington) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Jack Mark Fishaut is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Jack Mark Fishaut, MD
Po Box 796,
Friday Harbor, WA 98250-0796
Ph: (360) 370-5971 | Dr Jack Mark Fishaut, MD
235 Blair Ave,
Friday Harbor, WA 98250-0796
Ph: (360) 370-5971 |
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