Healthcare Provider Details

I. General information

NPI: 1184769879
Provider Name (Legal Business Name): DENARD MANUEL FOBBS SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5339 N FRESNO ST STE 105E
FRESNO CA
93710-6851
US

IV. Provider business mailing address

PO BOX 26990
FRESNO CA
93729-6990
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-7600
  • Fax: 559-225-2472
Mailing address:
  • Phone: 559-225-7600
  • Fax: 559-225-2472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberC38922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: