Provider Demographics
NPI:1972501617
Name:FISCHER, MARK W (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:FISCHER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1118 ROSS CLARK CIR
Mailing Address - Street 2:500
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3001
Mailing Address - Country:US
Mailing Address - Phone:334-794-4159
Mailing Address - Fax:334-792-7019
Practice Address - Street 1:1118 ROSS CLARK CIR
Practice Address - Street 2:500
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3001
Practice Address - Country:US
Practice Address - Phone:334-794-4159
Practice Address - Fax:334-792-7019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AL00011311208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76441Medicare UPIN