MEDICARE: INLAND ORTHOPEDIC MEDICAL INC.

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	174400000X	Specialist	A365140	CA

General Provider Information

NPI Number	:	1194943738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INLAND ORTHOPEDIC MEDICAL INC.

Provider Business Mailing Address
First Line	:	1850 S WATERMAN AVE
Second Line	:	SUITE E
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-2852
Country	:	US
Telephone Number	:	909-890-0977
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 S WATERMAN AVE
Second Line	:	SUITE E
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92408-2852
Country	:	US
Telephone Number	:	909-890-0977
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID EDISON FISHER
Credential	:	M.D.
Telephone Number	:	909-890-0977

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/22/2020

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