MEDICARE: TRAVIS FISHER MD

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	207R00000X	Internal Medicine Physician	96244	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366536732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS FISHER MD

Provider Business Mailing Address
First Line	:	1855 N STAPLEY DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-3002
Country	:	US
Telephone Number	:	480-834-7546
Fax Number	:	480-833-8313

Provider Business Practice Location Address
First Line	:	10238 E HAMPTON AVE STE 508
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-3321
Country	:	US
Telephone Number	:	480-834-7546
Fax Number	:	480-833-8313

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/23/2021

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Directions to “ TRAVIS FISHER MD” Practice Location

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