Individual
JACK ELLIOTT FISHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
8O 5TH ST, GILROY, CA 95020-5748
(408) 842-0281
(408) 848-4341
Mailing address
8O 5TH ST, GILROY, CA 95020-5748
(408) 842-0281
(408) 848-4341
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
E1702
CA
213ES0131X
Foot Surgery Podiatrist
E1702
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1629072392
INDIVIDUAL NPI
CA
01
—
1780794644
ENTITY NPI
CA
01
—
E1702
MEDICAL LICENSE
CA
Enumeration date
06/09/2005
Last updated
08/27/2014
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