Provider Demographics
NPI:1245318807
Name:FISHER, ALAN V (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:V
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 1:5512 CALAROSA RANCH RD
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-9089
Mailing Address - Country:US
Mailing Address - Phone:650-387-0014
Mailing Address - Fax:
Practice Address - Street 1:5512 CALAROSA RANCH RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-9089
Practice Address - Country:US
Practice Address - Phone:650-591-4749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36021207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G360210Medicaid
CA00G360210Medicaid
F16184Medicare UPIN