Organization
CHARLES B. FISHMAN, M.D., A PROFESSIONAL CORPORATION
Active
Organization
CHARLES B. FISHMAN, M.D., A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES B. FISHMAN M. D. (PRESIDENT)
(805) 541-4180
Entity
Organization
Contact information
Practice address
1551 BISHOP ST, SUITE 410, SAN LUIS OBISPO, CA 93401-4635
(805) 541-4180
(805) 541-2542
Mailing address
1551 BISHOP ST, SUITE 410, SAN LUIS OBISPO, CA 93401-4635
(805) 541-4180
(805) 541-2542
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
C 31365
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DD8042
MEDICARE, RAILROAD
CA
01
—
W18438
MEDICARE GROUP ID NUMBER
CA
Enumeration date
09/25/2007
Last updated
01/29/2008
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