Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 040429715 | KS |
N | 208G00000X | Cardiothoracic Vascular Surgeon | 60813 | WI |
N | 208G00000X | Cardiothoracic Vascular Surgeon | J9027 | TX |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD454858 | PA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME133610 | FL |
NPI | 1033116710 |
---|---|
Provider Name | Dr. Wade L Fischer |
First Address | Kissimmee, FL 34741-4910 |
Second Address | Kissimmee, FL 34741-4910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 27/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040881702 | (05) | TX |
040881703 | (05) | TX |
040881704 | (05) | TX |
100422820A | (05) | KS |
1033116710 | BLUE CROSS BLUE SHIELD (01) | TX |