=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023320108
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TYSON DALE FISHER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2010
-----------------------------------------------------
Last Update Date | 09/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 W 1ST ST STE 3
-----------------------------------------------------
City | ELK CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73644-3133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-757-3510
-----------------------------------------------------
Fax | 405-757-3511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 NE 85TH ST STE C
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73114-3916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-285-2744
-----------------------------------------------------
Fax | 405-295-4321
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | 31696
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------