Provider Demographics
NPI:1598748758
Name:FISHER, MARC F (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:F
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 2839
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-2839
Mailing Address - Country:US
Mailing Address - Phone:601-553-0707
Mailing Address - Fax:601-553-0775
Practice Address - Street 1:2514 67TH AVENUE LOOP
Practice Address - Street 2:SUITE
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-7259
Practice Address - Country:US
Practice Address - Phone:601-553-0707
Practice Address - Fax:601-553-0775
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009935510Medicaid
MS00122902Medicaid
080160931OtherRAILROAD MEDICARE
730-03220OtherBLUE CROSS OF AL
D80539Medicare UPIN
AL009935510Medicaid