Provider Demographics
NPI:1265634935
Name:FISHER, CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:FISHER
Other - Last Name:WACHTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2905 SAN GABRIEL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3548
Mailing Address - Country:US
Mailing Address - Phone:512-815-0123
Mailing Address - Fax:512-861-6206
Practice Address - Street 1:2905 SAN GABRIEL ST STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3548
Practice Address - Country:US
Practice Address - Phone:512-815-0123
Practice Address - Fax:512-861-6206
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT189375208200000X
TXP6387208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302442YTR7Medicare PIN