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NPI Code Detail

MEDICARE: DR. AILEEN FISHER MD

MEDICARE: DR. AILEEN 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
12084P0800XPsychiatry PhysicianK8151TX
22084P0805XGeriatric Psychiatry PhysicianK8151TX

General Provider Information

NPI Number : 1881783876
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AILEEN FISHER MD
Provider Business Mailing Address
First Line : 3540 E BROAD ST STE 120-374
Second Line :
City : MANSFIELD
State : TX
Zip : 76063-5633
Country : US
Telephone Number : 817-307-5257
Fax Number : 833-608-1543
Provider Business Practice Location Address
First Line : 3120 N CAMINO LAGOS
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75054-6790
Country : US
Telephone Number : 817-307-5257
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2006
Last Update Date : 10/04/2021

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