MEDICARE: DR. CHARLES HOWARD FISHER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	ME 25701	FL

General Provider Information

NPI Number	:	1699929380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES HOWARD FISHER M.D.

Provider Business Mailing Address
First Line	:	4904 ANDROS DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-4802
Country	:	US
Telephone Number	:	813-286-2166
Fax Number	:

Provider Business Practice Location Address
First Line	:	4904 ANDROS DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-4802
Country	:	US
Telephone Number	:	813-286-2166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2008
Last Update Date	:	12/15/2010

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