Healthcare Provider Details

I. General information

NPI: 1154766632
Provider Name (Legal Business Name): RYAN MATTHEW FISHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2789 S STATE ROAD 7 STE 100
WELLINGTON FL
33414-9360
US

IV. Provider business mailing address

2789 S STATE ROAD 7 STE 100
WELLINGTON FL
33414-9360
US

V. Phone/Fax

Practice location:
  • Phone: 561-898-5100
  • Fax: 561-898-5103
Mailing address:
  • Phone: 561-898-5100
  • Fax: 561-898-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ6189
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME153626
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: