Provider Demographics
NPI:1770740953
Name:WILLIAM D FISHCO DPM
Entity type:Organization
Organization Name:WILLIAM D FISHCO DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:FISHCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:602-993-2700
Mailing Address - Street 1:6036 N 19TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2106
Mailing Address - Country:US
Mailing Address - Phone:602-933-2700
Mailing Address - Fax:602-993-2705
Practice Address - Street 1:41818 N VENTURE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3188
Practice Address - Country:US
Practice Address - Phone:602-993-2700
Practice Address - Fax:602-993-2705
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLIAM D FISHCO DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-16
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZDC4277OtherRAILROAD MEDICARE
AZDC4277OtherRAILROAD MEDICARE
AZ4167680001Medicare NSC