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NPI Code Detail

MEDICARE: DR. LARRY BRIAN FISHER DMD

MEDICARE: DR. LARRY BRIAN FISHER DMD
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
11223G0001XGeneral Practice Dentistry1418739921UT

General Provider Information

NPI Number : 1942287784
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY BRIAN FISHER DMD
Provider Business Mailing Address
First Line : 6633 WIND RIDGE DR
Second Line :
City : EL PASO
State : TX
Zip : 79912-7328
Country : US
Telephone Number : 915-842-0748
Fax Number :
Provider Business Practice Location Address
First Line : 128 CHAFFEE ROAD
Second Line :
City : FORT BLISS
State : TX
Zip : 79906-3811
Country : US
Telephone Number : 915-568-1101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2005
Last Update Date : 07/08/2007

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