MEDICARE: JEFFREY R FISHER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	8753	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2374456004	OTHER	CIGNA 200
2	AZ824310	OTHER	BCBS
3	1424DB9	OTHER	FIRST HEALTH
4	1Z7303	OTHER	HEALTHNET
5	676950	OTHER	AETNA
6	860923905	OTHER	HUMANA PPO
7	2374456005	OTHER	CIGNA 210
8	5043793	OTHER	CCN

General Provider Information

NPI Number	:	1164424248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY R FISHER MD

Provider Business Mailing Address
First Line	:	5601 W EUGIE AVE
Second Line	:	STE 210
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1255
Country	:	US
Telephone Number	:	602-843-1313
Fax Number	:	602-843-0191

Provider Business Practice Location Address
First Line	:	5601 W EUGIE AVE
Second Line	:	STE 210
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1255
Country	:	US
Telephone Number	:	602-843-1313
Fax Number	:	602-843-0191

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	01/06/2010

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Directions to “ JEFFREY R FISHER MD” Practice Location

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