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NPI Code Detail

MEDICARE: JACOB FISHER PA-C

MEDICARE: JACOB FISHER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant10661AZ

General Provider Information

NPI Number : 1346017324
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB FISHER PA-C
Provider Business Mailing Address
First Line : 44572 W BOWLIN RD
Second Line :
City : MARICOPA
State : AZ
Zip : 85138-4558
Country : US
Telephone Number : 520-568-2245
Fax Number :
Provider Business Practice Location Address
First Line : 44572 W BOWLIN RD
Second Line :
City : MARICOPA
State : AZ
Zip : 85138-4558
Country : US
Telephone Number : 520-568-2245
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2023
Last Update Date : 09/25/2024

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