Provider Demographics
NPI:1578574299
Name:FISCHER, GARY W (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:W
Last Name:FISCHER
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 224137
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75222-4137
Mailing Address - Country:US
Mailing Address - Phone:254-776-0266
Mailing Address - Fax:254-776-2511
Practice Address - Street 1:405 LONDONDERRY DR.
Practice Address - Street 2:SUITE 105
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-776-0266
Practice Address - Fax:254-776-2511
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8108207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120252503Medicaid
TX120252503Medicaid