Healthcare Provider Details

I. General information

NPI: 1386693604
Provider Name (Legal Business Name): JEFFREY L FISCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 19TH AVE SW
WILLMAR MN
56201-4946
US

IV. Provider business mailing address

1801 19TH AVE SW
WILLMAR MN
56201-4946
US

V. Phone/Fax

Practice location:
  • Phone: 320-235-2020
  • Fax: 320-214-5761
Mailing address:
  • Phone: 320-235-2020
  • Fax: 320-214-5761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number39771
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: