Provider Demographics
NPI:1417920521
Name:FISHER, BRUCE D (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:D
Last Name:FISHER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4401
Mailing Address - Country:US
Mailing Address - Phone:406-727-7771
Mailing Address - Fax:406-771-6575
Practice Address - Street 1:1016 9TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4401
Practice Address - Country:US
Practice Address - Phone:406-262-3462
Practice Address - Fax:406-771-6575
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT145213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000390273Medicaid
MT000081233Medicare ID - Type Unspecified
MTU75006Medicare UPIN
MT0000390273Medicaid
MT011000019Medicare PIN