=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659884468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREGORY T. FISHER, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2017
-----------------------------------------------------
Last Update Date | 11/15/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17785 CENTER COURT DR N STE 130
-----------------------------------------------------
City | CERRITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90703-9305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-865-9600
-----------------------------------------------------
Fax | 562-865-9612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17785 CENTER COURT DR N STE 130
-----------------------------------------------------
City | CERRITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90703-9305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-865-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. GREGORY T FISHER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 562-865-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------