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Contact Information

JONATHAN D FISHER, DPM
30544 HIGHWAY 200
SUITE 102
PONDERAY, ID83852-5005
 Phone: 208-265-9817
 Fax: 208-265-4533
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Surgery, Foot & Ankle

213ES0103X 48 Podiatry
Indicates primary specialty

NPI Profile & details for JONATHAN D FISHER · (Male)

NPI Number 1891969606
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 04/14/2008
Last updated 06/23/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • ID License # P-198
  • ID Medicaid 808011000
  • ID Other P2448 BLUE CROSS
  • ID Other 1100300 MEDICARE
  • ID Other P00638389 RAILROAD MEDICARE
  • ID Other 000010167109 REGENCE BLUE SHIELD
Hospital affiliation(s)
  • BONNER GENERAL HOSPITAL - (Critical Access)
    520 NORTH THIRD AVENUE
    SANDPOINT, ID 83864
  • NEWPORT COMMUNITY HOSPITAL - (Critical Access)
    714 WEST PINE STREET
    NEWPORT, WA 99156
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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