Provider Demographics
NPI:1639151913
Name:FISCH, BRUCE J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:J
Last Name:FISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:130 RAMPART WAY
Mailing Address - Street 2:300-B
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6440
Mailing Address - Country:US
Mailing Address - Phone:303-327-4700
Mailing Address - Fax:303-327-4711
Practice Address - Street 1:9695 S YOSEMITE ST
Practice Address - Street 2:SUITE 285
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2888
Practice Address - Country:US
Practice Address - Phone:303-799-8760
Practice Address - Fax:303-799-8767
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2015-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO31254207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01312545Medicaid
COC462628OtherMEDICARE PTAN
COC462628OtherMEDICARE PTAN