MEDICARE: JIM C CHOW 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	207N00000X	Dermatology Physician	12850	SC
2	207ND0101X	MOHS-Micrographic Surgery Physician	12850	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	070017293	OTHER	SC	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1891768487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM C CHOW M.D.

Provider Business Mailing Address
First Line	:	3600 FOREST DR STE 400
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4057
Country	:	US
Telephone Number	:	803-779-7316
Fax Number	:	803-343-2538

Provider Business Practice Location Address
First Line	:	3600 FOREST DR STE 400
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-4057
Country	:	US
Telephone Number	:	803-779-7316
Fax Number	:	803-343-2538

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	03/07/2023

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Directions to “ JIM C CHOW M.D.” Practice Location

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