Provider Demographics
NPI:1093770638
Name:FISHER-OWENS, SUSAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A
Last Name:FISHER-OWENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:ALLEN
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:MAIL STOP 6E
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:415-206-8361
Mailing Address - Fax:415-206-3686
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:MAIL STOP 6E
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8361
Practice Address - Fax:415-206-3686
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87235208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A8723500Medicaid
CA0A8723500Medicaid
CA0A8723500Medicare PIN