Healthcare Provider Details

I. General information

NPI: 1477555340
Provider Name (Legal Business Name): SCOTT DAVID FISCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 02/12/2026
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5458 TOWN CENTER RD STE 25
BOCA RATON FL
33486-1009
US

IV. Provider business mailing address

5458 TOWN CENTER RD
BOCA RATON FL
33486-1089
US

V. Phone/Fax

Practice location:
  • Phone: 561-923-9635
  • Fax:
Mailing address:
  • Phone: 561-923-9635
  • Fax: 561-923-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MB07336500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS2488
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: