Provider Demographics
NPI:1134217516
Name:FISH, SHAY (DPM)
Entity type:Individual
Prefix:DR
First Name:SHAY
Middle Name:
Last Name:FISH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 291768
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-1768
Mailing Address - Country:US
Mailing Address - Phone:830-895-3400
Mailing Address - Fax:210-692-9529
Practice Address - Street 1:420 WATER ST
Practice Address - Street 2:SUITE 107
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5200
Practice Address - Country:US
Practice Address - Phone:830-895-3400
Practice Address - Fax:210-692-9529
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D0844Medicare ID - Type Unspecified
TXU35413Medicare UPIN