Provider Demographics
NPI:1467983056
Name:FISHER, MICHAEL GORDON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GORDON
Last Name:FISHER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4645 SWEETWATER BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3016
Mailing Address - Country:US
Mailing Address - Phone:281-302-5645
Mailing Address - Fax:281-565-1102
Practice Address - Street 1:4645 SWEETWATER BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3016
Practice Address - Country:US
Practice Address - Phone:281-302-5645
Practice Address - Fax:281-565-1102
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine