Healthcare Provider Details

I. General information

NPI: 1841211471
Provider Name (Legal Business Name): FREDERICK CHARLES FISHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N SIOUX POINT RD
DAKOTA DUNES SD
57049-5000
US

IV. Provider business mailing address

PO BOX 848
SIOUX FALLS SD
57101-0848
US

V. Phone/Fax

Practice location:
  • Phone: 605-232-3332
  • Fax: 605-232-0854
Mailing address:
  • Phone: 605-339-6525
  • Fax: 605-339-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4122
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: