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NPI Code Detail

MEDICARE: JOHN SAMUEL FISHER MD

MEDICARE: JOHN SAMUEL 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
1390200000XStudent in an Organized Health Care Education/Training ProgramTN
2208800000XUrology PhysicianME154092FL

General Provider Information

NPI Number : 1982059440
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN SAMUEL FISHER MD
Provider Business Mailing Address
First Line : 2708 W SAINT ISABEL ST FL 33607
Second Line :
City : TAMPA
State : FL
Zip : 33607-6320
Country : US
Telephone Number : 813-877-7434
Fax Number :
Provider Business Practice Location Address
First Line : 2708 W SAINT ISABEL ST FL 33607
Second Line :
City : TAMPA
State : FL
Zip : 33607-6320
Country : US
Telephone Number : 813-877-7434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2016
Last Update Date : 07/13/2022

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