Provider Demographics
NPI:1033146758
Name:FISH, JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:FISH
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 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG149102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAM421PMedicare PIN
CAA39375Medicare UPIN
CAAM421LMedicare PIN
CAAM421NMedicare PIN
CAAM421RMedicare PIN
CAAM421WMedicare PIN
CAAM421ZMedicare PIN
CA30097022Medicare PIN
CAAM421IMedicare PIN
CAAM421MMedicare PIN
CAAM421SMedicare PIN
CAAM421YMedicare PIN
CAAM421XMedicare PIN
CAAM421KMedicare PIN
CAAM421UMedicare PIN
CA300097065Medicare PIN
CAAM421VMedicare PIN
CA00G149100Medicare PIN
CA300096979Medicare PIN
CA300097062Medicare PIN
CAAM421OMedicare PIN
CAAM421QMedicare PIN
CAAM421TMedicare PIN
CAAM421JMedicare PIN