Provider Demographics
NPI:1104128636
Name:STEPHEN N FISHER MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:STEPHEN N FISHER MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-606-1681
Mailing Address - Street 1:1321 HOWE AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3365
Mailing Address - Country:US
Mailing Address - Phone:916-564-2225
Mailing Address - Fax:916-564-5926
Practice Address - Street 1:1321 HOWE AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3365
Practice Address - Country:US
Practice Address - Phone:916-564-2225
Practice Address - Fax:916-564-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-04
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54042261QP2300X, 261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care