Provider Demographics
NPI:1225038391
Name:FISHBERG, ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:FISHBERG
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 1:721 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7309
Mailing Address - Country:US
Mailing Address - Phone:407-735-6735
Mailing Address - Fax:855-855-6182
Practice Address - Street 1:721 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7309
Practice Address - Country:US
Practice Address - Phone:407-735-6735
Practice Address - Fax:855-618-2347
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052422207Q00000X
FLME95364207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000175651OtherBCBS
10810OtherPHP
080168837OtherRR MEDICARE
IN200276890AMedicaid
IN200276890AMedicaid
0000000175651OtherBCBS