Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 55044 | WI |
Y | 208600000X | Surgeon | 55044 | WI |
N | 208200000X | Surgeon | 57 . 007362 | OH |
N | 208600000X | Surgeon | 57 . 007362 | OH |
N | 2086S0102X | Surgical Critical Care | 55044 | WI |
N | 2086S0127X | Trauma Surgeon | 55044 | WI |
NPI | 1245452549 |
---|---|
Provider Name | Dr. Mason Gordon Fisher |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 20/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1245452549 | (05) | WI |