Provider Demographics
NPI:1508854266
Name:FISHER, BRUCE L (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:L
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 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-585-4321
Mailing Address - Fax:502-566-6338
Practice Address - Street 1:3920 DUTCHMANS LN STE 316
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-585-4321
Practice Address - Fax:502-566-6338
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039993A207RC0000X
KY23170207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN060014169OtherRAILROAD MEDICARE
IN200009600Medicaid
KYP00258374OtherRAILROAD MEDICARE
KY060057270OtherRAILROAD MEDICARE
KY64231707Medicaid
KY00314006Medicare PIN
KY0640904Medicare PIN
KY10600105Medicare PIN
IN228550BMedicare PIN
IN251440JMedicare PIN
KY0289307Medicare PIN
KYP00655132Medicare PIN
KY0690806Medicare PIN
KY00313006Medicare PIN
KYP00258374OtherRAILROAD MEDICARE
IN200009600Medicaid
KY1273206Medicare PIN
KY64231707Medicaid
KY00546139Medicare Oscar/Certification
KY0245401Medicare PIN
KY00311006Medicare PIN
KY00309006Medicare PIN
KY00312006Medicare PIN