Individual
MANUEL A FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
6606 LBJ FWY, STE 200, DALLAS, TX 75240
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 715-5000
(972) 715-9976
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
633514
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18463990
TEXAS DL
TX
05
—
202812801
—
TX
01
—
633514
STATE LICENSE
TX
01
—
89825U
BCBS
TX
01
—
P00738269
RAILROAD
TX
Enumeration date
12/23/2008
Last updated
06/17/2020
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