Provider Demographics
NPI:1427416551
Name:TYFMD PLLC
Entity Type:Organization
Organization Name:TYFMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:YOSHIO
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-822-1957
Mailing Address - Street 1:2931 RIDGE RD
Mailing Address - Street 2:STE 101-52
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-6670
Mailing Address - Country:US
Mailing Address - Phone:972-822-1957
Mailing Address - Fax:
Practice Address - Street 1:628 G ST
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-2544
Practice Address - Country:US
Practice Address - Phone:972-822-1957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052523261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00220GMedicaid
TX0220GMedicare PIN
TXF70549Medicare PIN