Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | G16541 | CA |
NPI | 1053320002 |
---|---|
Provider Name | Dr. Charles Ellis Moss Fisher |
First Address | Los Angeles, CA 90059 |
Second Address | Los Angeles, CA 90059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A90433 | (02) | CA |