Provider Demographics
NPI:1942311840
Name:FISHER, CRAIG DALE (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:DALE
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 1:20750 VENTURA BLVD
Mailing Address - Street 2:SUITE #210
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2338
Mailing Address - Country:US
Mailing Address - Phone:818-888-7815
Mailing Address - Fax:818-715-1722
Practice Address - Street 1:20750 VENTURA BLVD
Practice Address - Street 2:SUITE #210
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2338
Practice Address - Country:US
Practice Address - Phone:818-888-7815
Practice Address - Fax:818-715-1722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70413207L00000X
TXN8913207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF52344Medicare UPIN
CAG70413GMedicare ID - Type Unspecified
CAG70413FMedicare ID - Type Unspecified
CAAO239Medicare PIN