Provider Demographics
NPI:1578615977
Name:FISHER MEDICAL GROUP
Entity Type:Organization
Organization Name:FISHER MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-977-0661
Mailing Address - Street 1:13090 N 94TH DR
Mailing Address - Street 2:200
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4256
Mailing Address - Country:US
Mailing Address - Phone:623-977-0661
Mailing Address - Fax:623-972-0161
Practice Address - Street 1:13090 N 94TH DR
Practice Address - Street 2:200
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4256
Practice Address - Country:US
Practice Address - Phone:623-977-0661
Practice Address - Fax:623-972-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty