Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | MD29268 | OK |
NPI | 1023378759 |
---|---|
Provider Name | Robert Fischer |
First Address | Tulsa, OK 74136-7244 |
Second Address | Tulsa, OK 74135-5627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2012 |
Last Update Date | 30/10/2018 |