Provider Demographics
NPI:1386530194
Name:TYSON D FISHER MD PLLC
Entity type:Organization
Organization Name:TYSON D FISHER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-888-3893
Mailing Address - Street 1:4400 GRANT BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-0038
Mailing Address - Country:US
Mailing Address - Phone:405-888-3893
Mailing Address - Fax:
Practice Address - Street 1:4400 GRANT BLVD STE 104
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-0038
Practice Address - Country:US
Practice Address - Phone:405-888-3893
Practice Address - Fax:405-657-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty