Provider Demographics
NPI:1235466970
Name:FISCHER, CRAIG A (LMT)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:FISCHER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13250 CORBEL CIR APT 1413
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7864
Mailing Address - Country:US
Mailing Address - Phone:239-220-9943
Mailing Address - Fax:
Practice Address - Street 1:13250 CORBEL CIR APT 1413
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7864
Practice Address - Country:US
Practice Address - Phone:239-220-9943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA47132172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker