MEDICARE: DR. EDWARD NEIL FISHMAN D.O.

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	207QA0505X	Adult Medicine Physician	CA-20A6414	CA
2	207QA0505X	Adult Medicine Physician	OS-007153-L	PA
3	207QA0505X	Adult Medicine Physician	517	NV

General Provider Information

NPI Number	:	1659512762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD NEIL FISHMAN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 370854
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89137-0854
Country	:	US
Telephone Number	:	702-253-6888
Fax Number	:

Provider Business Practice Location Address
First Line	:	5375 S FORT APACHE RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-7623
Country	:	US
Telephone Number	:	702-253-6888
Fax Number	:

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

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	09/09/2014

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