Individual
DR. TED J FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3211 N NORTHHILLS BLVD, SUITE 110, FAYETTEVILLE, AR 72703-4007
(479) 571-4338
(479) 571-4015
Mailing address
3211 N NORTHHILLS BLVD, SUITE 110, FAYETTEVILLE, AR 72703-4007
(479) 571-4338
(479) 571-4015
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
N6731
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100177890A
—
OK
05
—
106458001
—
AR
01
—
122040000
QUALCHOICE
AR
01
—
1670493
UNITED HEALTHCARE
AR
05
—
204813208
—
MO
01
—
4574734
AETNA
AR
01
—
A012
CHAMPUS
AR
01
—
N6731
STATE LICENSE
AR
Enumeration date
04/17/2006
Last updated
03/07/2023
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