Provider Demographics
NPI:1447231014
Name:FISHER, TOBIN JOE (MD)
Entity Type:Individual
Prefix:
First Name:TOBIN
Middle Name:JOE
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 1:420 LOWELL DR SE
Mailing Address - Street 2:STE 103
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3754
Mailing Address - Country:US
Mailing Address - Phone:256-535-5940
Mailing Address - Fax:256-535-5959
Practice Address - Street 1:420 LOWELL DR SE
Practice Address - Street 2:STE 201
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3754
Practice Address - Country:US
Practice Address - Phone:256-535-5944
Practice Address - Fax:256-535-5959
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0005439740OtherAETNA
631222805OtherTAX IDENTIFICATION NO
080141952OtherRAILROAD MEDICARE
AL51008473OtherBLUE CROSS BLUE SHIELD
631222805OtherTAX IDENTIFICATION NO
AL000008473Medicare PIN