Provider Demographics
NPI:1326142795
Name:FISHER, DANIEL CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:CRAIG
Last Name:FISHER
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 1:6347 COYLE AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0438
Mailing Address - Country:US
Mailing Address - Phone:916-967-4278
Mailing Address - Fax:916-967-0385
Practice Address - Street 1:6347 COYLE AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0438
Practice Address - Country:US
Practice Address - Phone:916-967-4278
Practice Address - Fax:916-967-0385
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54920207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4056632OtherAETNA
CAA52828Medicare UPIN
CA00G549200Medicare PIN