Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 820 | WI |
N | 103TC0700X | Clinical Psychologist | 820 | WI |
N | 103TH0100X | Health Service | 820 | WI |
N | 103TR0400X | Rehabilitation Psychologist | 820 | WI |
NPI | 1316008303 |
---|---|
Provider Name | Dr. Thomas Fisher |
First Address | Milwaukee, WI 53207 |
Second Address | Milwaukee, WI 53207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40129 | NATIONAL REGISTER OF HEAL (01) |