Provider Demographics
NPI:1376534354
Name:FISHER, RICHARD G (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:FISHER
Suffix:
Gender:M
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 3119
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3119
Mailing Address - Country:US
Mailing Address - Phone:713-481-3533
Mailing Address - Fax:713-432-0221
Practice Address - Street 1:4600 E SAM HOUSTON PKWY S
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3948
Practice Address - Country:US
Practice Address - Phone:713-481-3533
Practice Address - Fax:713-432-0221
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD08732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138611207Medicaid
TX138611214Medicaid
TX138611213Medicaid
TX138611202Medicaid
TX8AM789OtherBCBS
TX138611214Medicaid
TX138611207Medicaid
TX8F0626Medicare PIN
TX138611202Medicaid
TX8K6310Medicare PIN
TX8L20174Medicare PIN
82R073Medicare PIN