Provider Demographics
NPI:1053337113
Name:FISHER, DAVID ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
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 1:3701 LONE TREE WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6038
Mailing Address - Country:US
Mailing Address - Phone:925-754-6767
Mailing Address - Fax:925-754-9668
Practice Address - Street 1:3701 LONE TREE WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6038
Practice Address - Country:US
Practice Address - Phone:925-754-6767
Practice Address - Fax:925-754-0137
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G106192Medicare ID - Type Unspecified
CAA38020Medicare UPIN