Provider Demographics
NPI:1205833886
Name:FISHER, DAVID H (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:FISHER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 N SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-2930
Mailing Address - Country:US
Mailing Address - Phone:505-523-2503
Mailing Address - Fax:
Practice Address - Street 1:335 N SOLANO DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-2930
Practice Address - Country:US
Practice Address - Phone:505-523-2503
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM149213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70012OtherHMO
NM5345OtherBLUE CROSS
NM54197Medicaid
NM70012OtherHMO
T41074Medicare UPIN