Provider Demographics
NPI:1639174576
Name:FISHER, ALAN JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:JEFFREY
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 1:612 W DUARTE RD
Mailing Address - Street 2:STE 705
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9246
Mailing Address - Country:US
Mailing Address - Phone:626-445-3301
Mailing Address - Fax:626-445-1020
Practice Address - Street 1:612 W DUARTE RD
Practice Address - Street 2:STE 705
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9246
Practice Address - Country:US
Practice Address - Phone:626-445-3301
Practice Address - Fax:626-445-1020
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44121174400000X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G441210Medicaid
CA00G441210Medicaid
CA00G441210Medicaid