Provider Demographics
NPI:1730155078
Name:FISH, MICHAEL NATHANIEL (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NATHANIEL
Last Name:FISH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10646 S ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7233
Mailing Address - Country:US
Mailing Address - Phone:918-269-5123
Mailing Address - Fax:918-298-2694
Practice Address - Street 1:516 E. NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-1337
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:505-722-1421
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2012-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005017275207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology