Provider Demographics
NPI:1568411593
Name:FISH, SUSAN KERSEY (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KERSEY
Last Name:FISH
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 1:2855 GRAMERCY ST STE 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1697
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:
Practice Address - Street 1:333 N. RIVERSHIRE DR.
Practice Address - Street 2:SUITE 160
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2711
Practice Address - Country:US
Practice Address - Phone:936-441-2020
Practice Address - Fax:936-756-0656
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1092207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173629002Medicaid
7599714OtherAETNA
4330254OtherBCBS LINK
8S4700OtherBLUE CROSS
P00259123OtherRAILROAD MEDICARE
7599714OtherAETNA
4330254OtherBCBS LINK