Provider Demographics
NPI:1396794699
Name:FISHER, DON D (DO)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:D
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-1033
Mailing Address - Country:US
Mailing Address - Phone:954-627-9118
Mailing Address - Fax:954-627-9822
Practice Address - Street 1:1451 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-1033
Practice Address - Country:US
Practice Address - Phone:954-627-9118
Practice Address - Fax:954-627-9822
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0003995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7342847OtherCIGNA
FL82312OtherBLUE CROSS BLUE SHIELD FL
FL82312OtherBLUE CROSS BLUE SHIELD FL
FL82312BMedicare ID - Type Unspecified
FLD84703Medicare UPIN