Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 0 | CA |
NPI | 1043746068 |
---|---|
Provider Name | Robert David Fisher |
First Address | San Diego, CA 92110-5765 |
Second Address | San Diego, CA 92110-5765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2017 |
Last Update Date | 11/05/2017 |