MEDICARE: DUKE D. FISHER, MD INC

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	2084P0800X	Psychiatry Physician	C027357	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1467499632	OTHER	CA	NPI DR. DUKE DE FISHER

General Provider Information

NPI Number	:	1699879619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUKE D. FISHER, MD INC

Provider Business Mailing Address
First Line	:	1010 CASS ST
Second Line	:	SUITE C-3
City	:	MONTEREY
State	:	CA
Zip	:	93940-4515
Country	:	US
Telephone Number	:	831-372-3018
Fax Number	:	831-372-5452

Provider Business Practice Location Address
First Line	:	1010 CASS ST
Second Line	:	SUITE C-3
City	:	MONTEREY
State	:	CA
Zip	:	93940-4515
Country	:	US
Telephone Number	:	831-372-3018
Fax Number	:	831-372-5452

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DUKE DE FISHER
Credential	:	MD
Telephone Number	:	831-372-3018

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	08/22/2020

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