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General NPI Number Information
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NPI Number | 1174623227
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Entity Type | Individual
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Provider Name | MARK DANIEL FISHER M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 200 HAWKINS DR 1534 JCP, DEPT OF SURGERY
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City | IOWA CITY
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State | IA
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Zip | 52242-1009
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Country | US
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Telephone | 319-353-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 200 HAWKINS DR 1534 JCP, DEPT OF SURGERY
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City | IOWA CITY
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State | IA
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Zip | 52242-1009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | BP20032170
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | MD-41973
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | MD449430
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License Number State | PA
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