Provider Demographics
NPI:1073685400
Name:WILLIAM J. FISHER, M.D., FACS, INC.
Entity Type:Organization
Organization Name:WILLIAM J. FISHER, M.D., FACS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-494-3656
Mailing Address - Street 1:1250 LA VENTA DR STE 202
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-3769
Mailing Address - Country:US
Mailing Address - Phone:805-494-3656
Mailing Address - Fax:805-496-8480
Practice Address - Street 1:1250 LA VENTA DR STE 202
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-3769
Practice Address - Country:US
Practice Address - Phone:805-494-3656
Practice Address - Fax:805-496-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC332322086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC33232OtherBLUE CROSS PIN
CA00C332320OtherBLUE SHIELD PIN
CA00C332320OtherBLUE SHIELD PIN