Provider Demographics
NPI:1154420016
Name:FISHER, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 RIVERBEND RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2626
Mailing Address - Country:US
Mailing Address - Phone:303-440-2456
Mailing Address - Fax:303-440-2427
Practice Address - Street 1:4801 RIVERBEND RD STE 100
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2626
Practice Address - Country:US
Practice Address - Phone:303-440-2456
Practice Address - Fax:303-440-2427
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO354332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
COG22305Medicare UPIN
COC29761Medicare ID - Type Unspecified