Provider Demographics
NPI:1952386765
Name:RISSER, JOSEPH A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:RISSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6973 LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-6339
Mailing Address - Country:US
Mailing Address - Phone:714-240-9046
Mailing Address - Fax:858-794-8305
Practice Address - Street 1:6973 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-6339
Practice Address - Country:US
Practice Address - Phone:714-240-9046
Practice Address - Fax:858-794-8305
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG70886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG70886COtherPPIN
E69392Medicare UPIN