Provider Demographics
NPI:1356728687
Name:FISHER, EMILY JEAN (MD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:FORDERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HAYWARD WELLNESS CENTER
Mailing Address - Street 2:664 SOUTHLAND MALL DR
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:664 SOUTHLAND MALL
Practice Address - Street 2:HAYWARD WELLNESS CENTER
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545
Practice Address - Country:US
Practice Address - Phone:510-266-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA171148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine