Provider Demographics
NPI:1366420994
Name:FANCHER, IRIS DENISE (MD)
Entity type:Individual
Prefix:DR
First Name:IRIS
Middle Name:DENISE
Last Name:FANCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:IRIS
Other - Middle Name:DENISE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2201 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-4221
Mailing Address - Country:US
Mailing Address - Phone:205-424-6001
Mailing Address - Fax:205-497-9369
Practice Address - Street 1:2201 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-4221
Practice Address - Country:US
Practice Address - Phone:205-424-6001
Practice Address - Fax:205-497-9369
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00013063208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC79100Medicare UPIN