MEDICARE: KENNETH FISHER MD

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	12762	AZ

General Provider Information

NPI Number	:	1780761957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH FISHER MD

Provider Business Mailing Address
First Line	:	1444 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1624
Country	:	US
Telephone Number	:	602-242-4843
Fax Number	:	602-433-7712

Provider Business Practice Location Address
First Line	:	1444 W BETHANY HOME RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-1624
Country	:	US
Telephone Number	:	602-242-4843
Fax Number	:	602-433-7712

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	08/31/2010

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