MEDICARE: BARRON CRAWFORD FISHBURNE 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	207W00000X	Ophthalmology Physician	19548	SC
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	19548	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316948243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRON CRAWFORD FISHBURNE M.D.

Provider Business Mailing Address
First Line	:	7620 TRENHOLM ROAD EXT
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1718
Country	:	US
Telephone Number	:	803-736-7200
Fax Number	:	803-736-2116

Provider Business Practice Location Address
First Line	:	7620 TRENHOLM ROAD EXT
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-1718
Country	:	US
Telephone Number	:	803-736-7200
Fax Number	:	803-736-2116

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	08/04/2017

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