Provider Demographics
NPI:1386693604
Name:FISCHER, JEFFREY L (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:FISCHER
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 1:1801 19TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:WILLMAR
Mailing Address - State:MN
Mailing Address - Zip Code:56201-4946
Mailing Address - Country:US
Mailing Address - Phone:320-235-2020
Mailing Address - Fax:320-214-5761
Practice Address - Street 1:1801 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4946
Practice Address - Country:US
Practice Address - Phone:320-235-2020
Practice Address - Fax:320-214-5761
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39771207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN849894600Medicaid
MN180044363OtherRAILROAD MEDICARE