Healthcare Provider Details

I. General information

NPI: 1629076237
Provider Name (Legal Business Name): MICHAEL FRANCIS FISHER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 MERCEY SPRINGS RD STE A
LOS BANOS CA
93635-3878
US

IV. Provider business mailing address

23280 LIGHTNER RD
GUYSVILLE OH
45735-9482
US

V. Phone/Fax

Practice location:
  • Phone: 209-829-0444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 979
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA891
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number64471
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA979
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110002760
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: