Healthcare Provider Details

I. General information

NPI: 1205875820
Provider Name (Legal Business Name): MARTIN L FISHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MONTEREY AVE SUITE 3
LOS GATOS CA
95030-5319
US

IV. Provider business mailing address

10300 S DE ANZA BLVD
CUPERTINO CA
95014-3030
US

V. Phone/Fax

Practice location:
  • Phone: 408-354-9510
  • Fax: 408-395-1610
Mailing address:
  • Phone: 408-252-7100
  • Fax: 408-257-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG26839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: