Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | 04-40003 | KS |
N | 2080P0204X | Pediatric Emergency Doctor | 2014008797 | MO |
Y | 2080P0204X | Pediatric Emergency Doctor | MD-47856 | IA |
NPI | 1114213451 |
---|---|
Provider Name | Dr. Tyler J Fisher |
First Address | Des Moines, IA 50309-1406 |
Second Address | Des Moines, IA 50309-1406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2011 |
Last Update Date | 05/10/2020 |