Healthcare Provider Details

I. General information

NPI: 1487982534
Provider Name (Legal Business Name): DESERT SURGICAL ASSOCIATES FISHER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 LA CANADA ST STE 217
LAS VEGAS NV
89169-2579
US

IV. Provider business mailing address

3131 LA CANADA ST STE 217
LAS VEGAS NV
89169-2579
US

V. Phone/Fax

Practice location:
  • Phone: 702-369-7152
  • Fax: 702-369-7153
Mailing address:
  • Phone: 702-369-7152
  • Fax: 702-369-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER J. FISHER
Title or Position: AUTHORIZED OFFICIAL/PARTNER
Credential: M.D.
Phone: 702-369-7152