Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 00567 | SC |
NPI | 1053360115 |
---|---|
Provider Name | Dr. Dana Justine Fisher |
First Address | Orangeburg, SC 29118 |
Second Address | Orangeburg, SC 29118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U96190 | (02) | SC |