Healthcare Provider Details

I. General information

NPI: 1255590964
Provider Name (Legal Business Name): GUSTAV FISCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST SUITE 626
PORTLAND OR
97213-2991
US

IV. Provider business mailing address

5050 NE HOYT ST SUITE 626
PORTLAND OR
97213-2991
US

V. Phone/Fax

Practice location:
  • Phone: 503-231-1426
  • Fax: 503-234-7015
Mailing address:
  • Phone: 503-231-1426
  • Fax: 503-234-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number6981
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD167189
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: