Provider Demographics
NPI:1285795047
Name:BRUCE D FISHER DPM PC
Entity type:Organization
Organization Name:BRUCE D FISHER DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:406-727-7771
Mailing Address - Street 1:1016 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4401
Mailing Address - Country:US
Mailing Address - Phone:406-727-7771
Mailing Address - Fax:406-771-6575
Practice Address - Street 1:1016 9TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4401
Practice Address - Country:US
Practice Address - Phone:406-727-7771
Practice Address - Fax:406-771-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT145213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000095326OtherBCBS OF MT
MT0390898Medicaid
MT0390898Medicaid
MT=========OtherINTERWEST
MT000095326OtherBCBS OF MT
MT=========59405A0001OtherTRICARE
MT0390898Medicaid
MTDF3486Medicare PIN