Basic Information
| Provider Information | |||||||||
| NPI: | 1528419553 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISH | ||||||||
| FirstName: | MEGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 650859 DEPT 710 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752655302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4097720620 | ||||||||
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| Practice Location | |||||||||
| Address1: | 215 OAK DR S STE D | ||||||||
| Address2: | |||||||||
| City: | LAKE JACKSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775665617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9792972755 | ||||||||
| FaxNumber: | 7178123499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2016 | ||||||||
| LastUpdateDate: | 06/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MT212035 | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0000X | S5369 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207V00000X | S5369 | TX | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.