Provider Demographics
NPI:1700970274
Name:FISHER, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 20730
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0730
Mailing Address - Country:US
Mailing Address - Phone:405-751-6440
Mailing Address - Fax:405-563-9368
Practice Address - Street 1:3524 NW 56TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4518
Practice Address - Country:US
Practice Address - Phone:405-751-6440
Practice Address - Fax:405-563-9368
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK196242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100214350AMedicaid
73-1614843OtherWATERSTONE BENEFIT
OK100214350AMedicaid