Provider Demographics
NPI:1740234418
Name:FISHER, MARTIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:B
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1604 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 507
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6986
Mailing Address - Country:US
Mailing Address - Phone:817-354-7268
Mailing Address - Fax:817-354-9930
Practice Address - Street 1:1604 HOSPITAL PKWY
Practice Address - Street 2:507
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6986
Practice Address - Country:US
Practice Address - Phone:817-354-7268
Practice Address - Fax:817-354-9930
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG50422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD90906Medicare UPIN
TX00J65LMedicare PIN