MEDICARE: DON D FISHER D.O.

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
1	207Q00000X	Family Medicine Physician	OS0003995	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7342847	OTHER	FL	CIGNA
2	82312	OTHER	FL	BLUE CROSS BLUE SHIELD FL

General Provider Information

NPI Number	:	1396794699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DON D FISHER D.O.

Provider Business Mailing Address
First Line	:	1451 NE 4TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1033
Country	:	US
Telephone Number	:	954-627-9118
Fax Number	:	954-627-9822

Provider Business Practice Location Address
First Line	:	1451 NE 4TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-1033
Country	:	US
Telephone Number	:	954-627-9118
Fax Number	:	954-627-9822

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	12/03/2008

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