Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | G55342 | CA |
N | 2080P0203X | Pediatric Critical Care Doctor | G55342 | CA |
NPI | 1144256470 |
---|---|
Provider Name | Brock C. Fisher |
First Address | San Diego, CA 92123-1810 |
Second Address | San Diego, CA 92123-1810 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 05/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G553420 | (05) | CA |
00G553420 | BLUE SHIELD OF CA (01) | CA |
E90524 | (02) | CA |