MEDICARE: MARY ANNETTE FISCHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA00080	TX

General Provider Information

NPI Number	:	1215122254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANNETTE FISCHER

Provider Business Mailing Address
First Line	:	PO BOX 451953
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75045-1953
Country	:	US
Telephone Number	:	972-680-1685
Fax Number	:

Provider Business Practice Location Address
First Line	:	9722 AMBERLEY DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-2303
Country	:	US
Telephone Number	:	972-680-1685
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	04/21/2011

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Directions to “ MARY ANNETTE FISCHER ” Practice Location

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