Healthcare Provider Details

I. General information

NPI: 1588714356
Provider Name (Legal Business Name): DANIEL BRIAN FISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 NE 3RD ST SUITE C
SEMINOLE TX
79360-3613
US

IV. Provider business mailing address

201 NE 3RD ST SUITE C
SEMINOLE TX
79360
US

V. Phone/Fax

Practice location:
  • Phone: 432-758-6015
  • Fax:
Mailing address:
  • Phone: 432-758-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License NumberJ6105
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberJ6015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: