Healthcare Provider Details

I. General information

NPI: 1386612760
Provider Name (Legal Business Name): CAROLINE E FISHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 NW 9TH ST
CORVALLIS OR
97330-3857
US

IV. Provider business mailing address

2727 NW 9TH ST
CORVALLIS OR
97330-3857
US

V. Phone/Fax

Practice location:
  • Phone: 503-269-3610
  • Fax:
Mailing address:
  • Phone: 503-269-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD157745
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD157745
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: