Provider Demographics
NPI:1396025102
Name:FISHER CARDIOLOGY AND ELECTROPHYSIOLOGY
Entity Type:Organization
Organization Name:FISHER CARDIOLOGY AND ELECTROPHYSIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:G
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-545-1355
Mailing Address - Street 1:1305 AIRPORT FWY
Mailing Address - Street 2:SUITE 424
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6605
Mailing Address - Country:US
Mailing Address - Phone:817-510-1060
Mailing Address - Fax:817-510-9940
Practice Address - Street 1:1305 AIRPORT FWY
Practice Address - Street 2:SUITE 424
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6605
Practice Address - Country:US
Practice Address - Phone:817-510-1060
Practice Address - Fax:817-510-9940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9453207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty