Provider Demographics
NPI:1609866276
Name:FISHER, KEITH A (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:A
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:11124 WURZBACH RD
Mailing Address - Street 2:STE 206
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2448
Mailing Address - Country:US
Mailing Address - Phone:210-696-0076
Mailing Address - Fax:210-697-7207
Practice Address - Street 1:11124 WURZBACH RD
Practice Address - Street 2:STE 206
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2438
Practice Address - Country:US
Practice Address - Phone:210-696-0076
Practice Address - Fax:210-697-7207
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM23212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry