Basic Information
| Provider Information | |||||||||
| NPI: | 1992789598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7951 E MAPLEWOOD AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801114723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039307800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2030 MTN VIEW DR | ||||||||
| Address2: | STE 210 | ||||||||
| City: | LONGMONT | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036841900 | ||||||||
| FaxNumber: | 3036841925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 07/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 40240 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 68472218 | 05 | CO | MEDICAID |