Healthcare Provider Details

I. General information

NPI: 1538531538
Provider Name (Legal Business Name): CHRISTOPHER FISHER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7140 SMOKE RANCH RD STE 150
LAS VEGAS NV
89128-3157
US

IV. Provider business mailing address

10124 DESERT WIND DR
LAS VEGAS NV
89144-6508
US

V. Phone/Fax

Practice location:
  • Phone: 702-556-0519
  • Fax:
Mailing address:
  • Phone: 702-556-0519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number13659
License Number StateNV

VIII. Authorized Official

Name: CHRISTOPHER FISHER
Title or Position: PROVIDER MD
Credential: MD
Phone: 702-556-0519