Provider Demographics
NPI:1598881039
Name:FISCHER, DESMOND LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:DESMOND
Middle Name:LAWRENCE
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 21891
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0891
Mailing Address - Country:US
Mailing Address - Phone:423-892-9729
Mailing Address - Fax:423-648-9040
Practice Address - Street 1:1313 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2934
Practice Address - Country:US
Practice Address - Phone:423-892-9729
Practice Address - Fax:423-648-9040
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000184852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100052419OtherPHP TENNCARE
TN3402061Medicaid
TN3402061OtherFIRST HEALTH
TN621385292OtherJOHN DEERE
TN702044421OtherCARITEN
TN3075999OtherBLUE CROSS TN
TN702010734OtherCARITEN SENIOR HEALTH
SC3402061OtherHUMANA TRICARE
TN702010734OtherCARITEN SENIOR HEALTH