MEDICARE: DR. STUART FISHER M.D.

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	208800000X	Urology Physician	C30650	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C30650	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1306882618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STUART FISHER M.D.

Provider Business Mailing Address
First Line	:	12922 VICTORY BLVD
Second Line	:	ASSUTA FAMILY MEDICAL GROUP APMC
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-2924
Country	:	US
Telephone Number	:	818-760-2800
Fax Number	:	818-760-7343

Provider Business Practice Location Address
First Line	:	12922 VICTORY BLVD
Second Line	:	ASSUTA FAMILY MEDICAL GROUP APMC
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-2924
Country	:	US
Telephone Number	:	818-760-2800
Fax Number	:	818-760-7343

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	12/15/2011

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Directions to “ DR. STUART FISHER M.D.” Practice Location

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