Healthcare Provider Details

I. General information

NPI: 1174903405
Provider Name (Legal Business Name): MARK ANDREW FISHER MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 BLUE SAGE RD
OKLAHOMA CITY OK
73120-5925
US

IV. Provider business mailing address

12000 BLUE SAGE RD
OKLAHOMA CITY OK
73120-5925
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-6181
  • Fax:
Mailing address:
  • Phone: 405-601-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number19624
License Number StateOK

VIII. Authorized Official

Name: MARK FISHER
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 405-550-4403