Individual
MR. MICHAEL ALEXANDER FISHMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
550 RIVER RD, EUGENE, OR 97404-3212
(541) 743-2611
Mailing address
550 RIVER RD, EUGENE, OR 97404-3212
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93-0605174
—
OR
Enumeration date
11/28/2012
Last updated
11/28/2012
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