Healthcare Provider Details

I. General information

NPI: 1205833886
Provider Name (Legal Business Name): DAVID H. FISHER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 N SOLANO DR
LAS CRUCES NM
88001-2930
US

IV. Provider business mailing address

335 N SOLANO DR
LAS CRUCES NM
88001-2930
US

V. Phone/Fax

Practice location:
  • Phone: 505-523-2503
  • Fax:
Mailing address:
  • Phone: 505-523-2503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number149
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: