Individual
JONATHAN DONALD FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
30544 HIGHWAY 200, SUITE 102, PONDERAY, ID 83852-5005
(208) 265-9817
(208) 265-4533
Mailing address
30544 HIGHWAY 200, SUITE 102, PONDERAY, ID 83852-5005
(208) 265-9817
(208) 265-4533
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P-198
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010167109
REGENCE BLUE SHIELD
ID
01
—
1100300
MEDICARE
ID
05
—
808011000
—
ID
01
—
P00638389
RAILROAD MEDICARE
ID
01
—
P2448
BLUE CROSS
ID
Enumeration date
04/14/2008
Last updated
06/23/2021
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