Provider Demographics
NPI:1184997561
Name:FISHER, ANTON (DO)
Entity type:Individual
Prefix:DR
First Name:ANTON
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 N RAINBOW BLVD STE 215
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1189
Mailing Address - Country:US
Mailing Address - Phone:725-333-2411
Mailing Address - Fax:702-952-5257
Practice Address - Street 1:800 N RAINBOW BLVD STE 215
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-1189
Practice Address - Country:US
Practice Address - Phone:725-333-2411
Practice Address - Fax:702-952-5257
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0065402084P0800X
FLOS121232084P0800X
TXR23322084P0800X
CA148282084P0800X
PAOS0173942084P0800X
NVCL00212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1184997561Medicaid