Provider Demographics
NPI:1912929928
Name:FISHER, JAMES B (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:B
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 1:307 SAINT JOHNS WAY
Mailing Address - Street 2:SUITE 17
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2435
Mailing Address - Country:US
Mailing Address - Phone:208-746-9644
Mailing Address - Fax:208-746-0782
Practice Address - Street 1:307 SAINT JOHNS WAY
Practice Address - Street 2:SUITE 17
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2435
Practice Address - Country:US
Practice Address - Phone:208-746-9644
Practice Address - Fax:208-746-0782
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM3622207R00000X
WAMD00014668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010004097OtherREGENCE BLUE SHIELD
WA1073816Medicaid
ID36228OtherBLUE CROSS OF IDAHO
ID36228OtherBLUE CROSS OF IDAHO
ID1112119Medicare ID - Type Unspecified
ID000010004097OtherREGENCE BLUE SHIELD