Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 31696 | OK |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 4301096728 | MI |
NPI | 1023320108 |
---|---|
Provider Name | Dr. Tyson Dale Fisher |
First Address | Edmond, OK 73013-8504 |
Second Address | Elk City, OK 73644-3133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2010 |
Last Update Date | 15/03/2019 |