Provider Demographics
NPI:1215116652
Name:FICHTER, MICHAEL PAUL JR (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:FICHTER
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 RICHLAND WEST CIR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7919
Mailing Address - Country:US
Mailing Address - Phone:254-235-9355
Mailing Address - Fax:254-235-0904
Practice Address - Street 1:321 RICHLAND WEST CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7919
Practice Address - Country:US
Practice Address - Phone:254-235-9355
Practice Address - Fax:254-235-0904
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05778363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284115704Medicaid
TXTXB149649Medicare Oscar/Certification