Basic Information
| Provider Information | |||||||||
| NPI: | 1073551842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17137 MAGNOLIA ISLAND BLVD | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347115936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3522439114 | ||||||||
| FaxNumber: | 3522437822 | ||||||||
| Practice Location | |||||||||
| Address1: | 1099 CITRUS TOWER BLVD | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347111947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523944071 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ME71566 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 35935 | 01 | BLUE CROSS BLUE SHIELD | OTHER | 50084555 | 01 | RAILROAD MEDICARE | OTHER |