Provider Demographics
NPI:1326873878
Name:FISCHER, DOUGLAS (RD)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:FISCHER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20991 SPINNAKER ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8428
Mailing Address - Country:US
Mailing Address - Phone:714-514-5946
Mailing Address - Fax:
Practice Address - Street 1:20991 SPINNAKER ST UNIT 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8428
Practice Address - Country:US
Practice Address - Phone:714-514-5946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10218795133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered