MEDICARE: DR. TYLER FISHER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	79134	AZ

General Provider Information

NPI Number	:	1053057679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER FISHER MD

Provider Business Mailing Address
First Line	:	502 W HIGHLAND BLVD
Second Line	:
City	:	INVERNESS
State	:	FL
Zip	:	34452-4720
Country	:	US
Telephone Number	:	352-344-6969
Fax Number	:

Provider Business Practice Location Address
First Line	:	10146 E OLD VAIL RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85747-9406
Country	:	US
Telephone Number	:	520-574-7400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2022
Last Update Date	:	06/01/2026

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