Provider Demographics
NPI:1245763127
Name:FISH, TEK (DPM)
Entity Type:Individual
Prefix:DR
First Name:TEK
Middle Name:
Last Name:FISH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-2037
Mailing Address - Country:US
Mailing Address - Phone:360-450-6644
Mailing Address - Fax:360-524-7847
Practice Address - Street 1:405 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-2037
Practice Address - Country:US
Practice Address - Phone:360-450-6644
Practice Address - Fax:360-524-7847
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO-61058890213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery