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Individual
MARK DOUGLAS FISH
Active
Individual
MARK DOUGLAS FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
02003044A
IN
207X00000X
Orthopaedic Surgery Physician
Primary
3790
IA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
02003044A
IN
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
02003044A
IN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
02003044A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000480577
BCBS
IN
01
—
075965
SIHO
IN
01
—
2655165
UNITED HEALTH CARE
IN
01
—
4178250001
DME
IN
01
—
7305819
AETNA
IN
01
—
P00325521
RR MEDICARE
IN
Enumeration date
05/17/2006
Last updated
01/23/2013
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