Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 64979 | MN |
NPI | 1669897500 |
---|---|
Provider Name | Dr. Casey Fisher |
First Address | Philadelphia, PA 19131-1626 |
Second Address | Robbinsdale, MN 55422-2978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2014 |
Last Update Date | 02/07/2019 |