Provider Demographics
NPI:1164424248
Name:FISHER, JEFFREY R (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:R
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 W EUGIE AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1255
Mailing Address - Country:US
Mailing Address - Phone:602-843-1313
Mailing Address - Fax:602-843-0191
Practice Address - Street 1:5601 W EUGIE AVE
Practice Address - Street 2:STE 210
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1255
Practice Address - Country:US
Practice Address - Phone:602-843-1313
Practice Address - Fax:602-843-0191
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8753207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2374456004OtherCIGNA 200
AZ824310OtherBCBS
1424DB9OtherFIRST HEALTH
1Z7303OtherHEALTHNET
676950OtherAETNA
860923905OtherHUMANA PPO
2374456005OtherCIGNA 210
5043793OtherCCN
676950OtherAETNA
1424DB9OtherFIRST HEALTH
110173206Medicare ID - Type UnspecifiedRR