Individual
KEITH R FISH
Active
Individual
KEITH R FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1382969
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010038296CT03
ANTHEM BCBS
—
01
—
2V5140
HEALTHNET
—
01
—
36549485
TRI-CARE
—
Enumeration date
08/31/2006
Last updated
10/07/2016
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