Provider Demographics
NPI:1831150580
Name:FISHER, KEVIN TODD (DO)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:TODD
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2448 E 81ST ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-4205
Mailing Address - Country:US
Mailing Address - Phone:918-505-3400
Mailing Address - Fax:918-508-7070
Practice Address - Street 1:2448 E 81ST ST STE 1100
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-4205
Practice Address - Country:US
Practice Address - Phone:918-505-3400
Practice Address - Fax:918-508-7070
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK3187208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100199470CMedicaid
OK100199470CMedicaid