Provider Demographics
NPI:1972525293
Name:FISCH, JASON P (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:FISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:511 W FM 544
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4581
Mailing Address - Country:US
Mailing Address - Phone:469-800-2400
Mailing Address - Fax:469-800-2410
Practice Address - Street 1:511 W FM 544
Practice Address - Street 2:SUITE 204
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4581
Practice Address - Country:US
Practice Address - Phone:469-800-2400
Practice Address - Fax:469-800-2410
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2691207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118412903Medicaid
TX350882YKTPMedicare PIN
TXG83091Medicare UPIN
TX080134560Medicare PIN
TX118412903Medicaid