Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2020010472 | MO |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 2020010472 | MO |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 85884 | SC |
NPI | 1568859700 |
---|---|
Provider Name | Dr. Brian Matthew Fisher |
First Address | Greenville, SC 29601-2842 |
Second Address | Easley, SC 29640-3040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2015 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IL |