Fish, Mark Douglas
Fish, Mark Douglas is an individual health care provider with primary practice located at 12499 University Ave Ste. 210, Clive IA 50325-8288. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Foot and Ankle Surgery, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Orthopaedic Surgery is his primary health care specialty. Fish, Mark Douglas can be contacted via phone (515) 440-2676.Contact Information
Primary practice address
12499 University Ave Ste. 210
Clive IA 50325-8288
Phone: (515) 440-2676
Fax: (515) 440-2677
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 3790 | Iowa |
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 02003044A | Indiana |
| Allopathic & Osteopathic Physicians / Adult Reconstructive Orthopaedic Surgery | 207XS0114X | 02003044A | Indiana |
| Allopathic & Osteopathic Physicians / Foot and Ankle Surgery | 207XX0004X | 02003044A | Indiana |
| Allopathic & Osteopathic Physicians / Sports Medicine | 207XX0005X | 02003044A | Indiana |
Profile Details
| NPI number | 1548212368 |
|---|---|
| LBN Legal business name | Fish, Mark Douglas |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 17th, 2006 |
| Last updated | Jan 23rd, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548212368 | NPPES |
| Indiana | Other | 000000480577 | BCBS |
| Indiana | Other | P00325521 | BCBS |
| Indiana | Other | 7305819 | BCBS |
| Indiana | Other | 4178250001 | BCBS |
| Indiana | Other | 075965 | BCBS |
| Indiana | Other | 2655165 | BCBS |
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