Provider Demographics
NPI:1861401135
Name:FISHER, BRUCE D (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:D
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1945 ROUTE 33
Mailing Address - Street 2:DEPARTMENT OF MEDICINE - JERSEY SHORE UNIV MED CTR
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07754-0397
Mailing Address - Country:US
Mailing Address - Phone:732-776-4420
Mailing Address - Fax:732-776-3795
Practice Address - Street 1:1945 ROUTE 33
Practice Address - Street 2:DEPARTMENT OF MEDICINE - JERSEY SHORE UNIV MED CTR
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-0397
Practice Address - Country:US
Practice Address - Phone:732-776-4420
Practice Address - Fax:732-776-3795
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03611300207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1641701Medicaid
NJFI45337Medicare ID - Type Unspecified
NJC55459Medicare UPIN