Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MA68626 | NJ |
Y | 207V00000X | Obstetrician & Gynecologist | MD2007-0662 | NM |
NPI | 1003852716 |
---|---|
Provider Name | Dr. Mark Allen Fisher |
First Address | Farmington, NM 87401-5915 |
Second Address | Farmington, NM 87401-5915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2006 |
Last Update Date | 11/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12986062 | (05) | NM |