Healthcare Provider Details

I. General information

NPI: 1215952999
Provider Name (Legal Business Name): MAYER FISHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR GU PROGRAM
TAMPA FL
33612-9416
US

IV. Provider business mailing address

12902 USF MAGNOLIA DR GU PROGRAM
TAMPA FL
33612-9416
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-8343
  • Fax: 813-745-8494
Mailing address:
  • Phone: 813-745-8343
  • Fax: 813-745-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME74715
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME74715
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: