Individual
TIMOTHY DEAN FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01047162A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000191349
ANTHEM PROVIDER NUMBER
IN
01
—
10825081
CAQH NUMBER
IN
05
—
200239110
—
IN
01
—
9397064
PHCS PID NUMBER
IN
Enumeration date
03/16/2006
Last updated
02/02/2021
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