Healthcare Provider Details

I. General information

NPI: 1588849491
Provider Name (Legal Business Name): FAIRFIELD ON-CALL SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 B GALE WILSON BLVD
FAIRFIELD CA
94533-3552
US

IV. Provider business mailing address

PO BOX 79610
CITY OF INDUSTRY CA
91716-9610
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-5082
  • Fax: 707-429-6937
Mailing address:
  • Phone: 330-470-3700
  • Fax: 330-497-7940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ELWOOD PAUL REID
Title or Position: CEO
Credential: MD
Phone: 866-885-5522