MEDICARE: MR. KEITH DENTON FISHER M.D.

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	207WX0107X	Retina Specialist (Ophthalmology) Physician	H2374	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	180039966	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4307768	OTHER	AETNA
2	751869812	OTHER	COMMERCIAL INS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265423107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH DENTON FISHER M.D.

Provider Business Mailing Address
First Line	:	909 9TH AVENUE
Second Line	:	#404
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3918
Country	:	US
Telephone Number	:	817-332-1782
Fax Number	:	817-336-8619

Provider Business Practice Location Address
First Line	:	909 9TH AVENUE
Second Line	:	#404
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3918
Country	:	US
Telephone Number	:	817-332-1782
Fax Number	:	817-336-8619

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	04/07/2017

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