Provider Demographics
NPI:1225002819
Name:FIESELER, CATHERINE M (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:M
Last Name:FIESELER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6450
Mailing Address - Fax:
Practice Address - Street 1:1327 TROUP HWY
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-510-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL79452081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123908OtherCHIPS
TX750818167007OtherTRICARE
TXFE08G0399OtherBCBS
TX164217501Medicaid
TX8DH351OtherBCBS
TXP00194174OtherMEDICARE RAILROAD
TXP01105225OtherRAIL ROAD
TX4343058OtherAETNA
TX752616977021OtherTRICARE CHAMPUS
TX164217502Medicaid
TX4343058OtherAETNA
TXTXB160305Medicare Oscar/Certification
TX123908OtherCHIPS
TX164217501Medicaid