Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 02003044A | IN |
Y | 207X00000X | Orthopaedic Surgeon | 3790 | IA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 02003044A | IN |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 02003044A | IN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 02003044A | IN |
NPI | 1548212368 |
---|---|
Provider Name | Mark Douglas Fish |
First Address | Clive, IA 50325-8288 |
Second Address | Clive, IA 50325-8288 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 23/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000480577 | BCBS (01) | IN |
075965 | SIHO (01) | IN |
2655165 | UNITED HEALTH CARE (01) | IN |
4178250001 | DME (01) | IN |
7305819 | AETNA (01) | IN |
I52359 | (02) | |
P00325521 | RR MEDICARE (01) | IN |