Provider Demographics
NPI:1922299106
Name:FISHER, MATTHEW SCOTT (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SCOTT
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-2156
Mailing Address - Country:US
Mailing Address - Phone:972-233-1999
Mailing Address - Fax:972-233-3666
Practice Address - Street 1:4144 N CENTRAL EXPY
Practice Address - Street 2:STE 360
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2156
Practice Address - Country:US
Practice Address - Phone:214-827-7460
Practice Address - Fax:214-826-6858
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006100207L00000X
AK6401207L00000X
IN02003359A207L00000X
TXP5361207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ830497Medicaid