Provider Demographics
NPI:1164587358
Name:FISHMAN, BRUCE E (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:E
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:E
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16661 VENTURA BLVD.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1902
Mailing Address - Country:US
Mailing Address - Phone:818-808-2828
Mailing Address - Fax:818-788-0386
Practice Address - Street 1:16661 VENTURA BLVD.
Practice Address - Street 2:SUITE 108
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1902
Practice Address - Country:US
Practice Address - Phone:818-808-2828
Practice Address - Fax:818-788-0386
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49562207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF06733Medicare UPIN