Provider Demographics
NPI:1548429319
Name:DR. SPENCER C DISHER
Entity Type:Organization
Organization Name:DR. SPENCER C DISHER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:C
Authorized Official - Last Name:DISHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-534-3503
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1266
Mailing Address - Country:US
Mailing Address - Phone:803-534-3503
Mailing Address - Fax:803-534-3510
Practice Address - Street 1:196 CENTRE ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-6044
Practice Address - Country:US
Practice Address - Phone:803-534-3503
Practice Address - Fax:803-534-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB918830281Medicare PIN