Provider Demographics
NPI:1588714356
Name:FISH, DANIEL BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRIAN
Last Name:FISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 NE 3RD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360
Mailing Address - Country:US
Mailing Address - Phone:432-758-6015
Mailing Address - Fax:
Practice Address - Street 1:201 NE 3RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3613
Practice Address - Country:US
Practice Address - Phone:432-758-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6105207RM1200X
TXJ6015207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140091323Medicaid
TX00R09KMedicare PIN
TX140091323Medicaid