MEDICARE: MARQUS ELLERY FISHER PT, MSM

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	208100000X	Physical Medicine & Rehabilitation Physician	PT6706	FL

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

General Provider Information

NPI Number	:	1518572148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUS ELLERY FISHER PT, MSM

Provider Business Mailing Address
First Line	:	3985 NW COLONIAL GLN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4857
Country	:	US
Telephone Number	:	305-458-5073
Fax Number	:

Provider Business Practice Location Address
First Line	:	289 SW STONEGATE TER STE 101
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-3457
Country	:	US
Telephone Number	:	386-401-4309
Fax Number	:	386-400-5109

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

Provider Enumeration Date	:	09/10/2020
Last Update Date	:	09/10/2020

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