Healthcare Provider Details

I. General information

NPI: 1417997693
Provider Name (Legal Business Name): DENNIS JEFFREY FISHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GAMECOCK AVE SUITE E
CHARLESTON SC
29407-3368
US

IV. Provider business mailing address

PO BOX 13955
CHARLESTON SC
29422-3955
US

V. Phone/Fax

Practice location:
  • Phone: 843-763-9664
  • Fax: 843-763-2949
Mailing address:
  • Phone: 843-763-9664
  • Fax: 843-763-2949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8383
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: