Provider Demographics
NPI:1275892887
Name:FISHER, JULIE MICHELE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:MICHELE
Last Name:FISHER
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 1:601 LEAH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7849
Mailing Address - Country:US
Mailing Address - Phone:512-392-1700
Mailing Address - Fax:512-396-8743
Practice Address - Street 1:601 LEAH AVE
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7849
Practice Address - Country:US
Practice Address - Phone:512-392-1700
Practice Address - Fax:512-396-8743
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ3183208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX429026YTMGOtherPTAN