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General NPI Number Information
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NPI Number | 1588669691
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Entity Type | Individual
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Provider Name | JEFFREY JAMES FISHER M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 01/29/2014
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Provider Practice Location Address
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Address Line | 1811 HIGHWAY 287 N STE 150
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City | MANSFIELD
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State | TX
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Zip | 76063-7595
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Country | US
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Telephone | 817-473-3979
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Fax | 682-518-8919
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Provider Business Mailing Address
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Address Line | 1811 HIGHWAY 287 N SUITE 150
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City | MANSFIELD
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State | TX
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Zip | 76063-7571
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Country | US
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Telephone | 817-473-3979
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Fax | 682-518-8919
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M0073
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License Number State | TX
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