1487759205 NPI number — DUKE D. FISHER, MD INC

Table of content: (NPI 1487759205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487759205 NPI number — DUKE D. FISHER, MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUKE D. FISHER, MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487759205
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1010 CASS ST
Provider Second Line Business Mailing Address:
SUITE C-3
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-363-6533
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
841 BLOSSOM HILL RD
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-372-3018
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
DUKE
Authorized Official Middle Name:
DE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
408-363-6533

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  C027357 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1467499632 . This is a "NPI DUKE DE FISHER, MD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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