Provider Demographics
NPI:1265423107
Name:FISHER, KEITH DENTON (MD)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:DENTON
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:909 9TH AVENUE
Mailing Address - Street 2:#404
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3918
Mailing Address - Country:US
Mailing Address - Phone:817-332-1782
Mailing Address - Fax:817-336-8619
Practice Address - Street 1:909 9TH AVENUE
Practice Address - Street 2:#404
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3918
Practice Address - Country:US
Practice Address - Phone:817-332-1782
Practice Address - Fax:817-336-8619
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2374207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4307768OtherAETNA
751869812OtherCOMMERCIAL INS
TX117768501Medicaid
180039966OtherRAILROAD MEDICARE
TX117768501Medicaid
TX8256K0Medicare ID - Type Unspecified