Provider Demographics
NPI:1023320108
Name:FISHER, TYSON DALE (MD)
Entity type:Individual
Prefix:DR
First Name:TYSON
Middle Name:DALE
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2017 W I 35 FRONTAGE RD
Mailing Address - Street 2:140
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-8504
Mailing Address - Country:US
Mailing Address - Phone:405-757-3510
Mailing Address - Fax:405-757-3511
Practice Address - Street 1:1800 W 1ST ST
Practice Address - Street 2:STE 3
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-3133
Practice Address - Country:US
Practice Address - Phone:405-757-3510
Practice Address - Fax:405-757-3511
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301096728207Y00000X
OK31696207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology