Healthcare Provider Details

I. General information

NPI: 1164442497
Provider Name (Legal Business Name): MONTE P FISHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 IRVING ST SUITE #137
SAN FRANCISCO CA
94122-2216
US

IV. Provider business mailing address

1032 IRVING ST SUITE #137
SAN FRANCISCO CA
94122-2216
US

V. Phone/Fax

Practice location:
  • Phone: 415-624-4836
  • Fax: 415-566-1174
Mailing address:
  • Phone: 415-624-4836
  • Fax: 415-566-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA69053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: