Provider Demographics
NPI:1700846946
Name:FISHER, EDMUND (MD)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:
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 1:4450 CALIFORNIA AVE
Mailing Address - Street 2:PO BOX 314
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1152
Mailing Address - Country:US
Mailing Address - Phone:661-323-6200
Mailing Address - Fax:661-323-6223
Practice Address - Street 1:5301 TRUXTUN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0742
Practice Address - Country:US
Practice Address - Phone:661-323-6200
Practice Address - Fax:661-323-6223
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60418207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A604180Medicaid
CAP00061888OtherRAILROAD MEDICARE
CA00A604181Medicare PIN
CA00A604182Medicare PIN
CA00A604180Medicare ID - Type Unspecified
CA00A604180Medicaid