Stephen M Fish, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00024257 Issued in WA

Practice address

404 Main Ave S
North Bend, WA 98045-8215

Phone

(425) 888-5511

Fax

(425) 888-5513

NPI assigned

May 16, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288137600000",
    "number": "1366493959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 969",
            "city": "SNOQUALMIE",
            "state": "WA",
            "postal_code": "980650969",
            "telephone_number": "425-888-5511",
            "fax_number": "425-888-5513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 MAIN AVE S",
            "city": "NORTH BEND",
            "state": "WA",
            "postal_code": "980458215",
            "telephone_number": "425-888-5511",
            "fax_number": "425-888-5513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISH",
        "first_name": "STEPHEN",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2010-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00024257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAILBLAZER MEDICARE FIRST LOCATION",
            "identifier": "8TA009",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1042852",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAILBLAZER MEDICARE SECOND LOCATION",
            "identifier": "8TA098",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nicholas James Fetner, RN
• Jean M Fitzharris, MA
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• Amber Follini, LPN
• Fred Meyer Stores Inc
• Rodger A. Galloway, D.D.S.

• Family Medicine Physician in North Bend, WA
• Providers in North Bend, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.