Healthcare Provider Details

I. General information

NPI: 1932177839
Provider Name (Legal Business Name): DONALD W. FIELDS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 N WAYTE LN
FRESNO CA
93701-2124
US

IV. Provider business mailing address

9590 N KEYSTONE CT
FRESNO CA
93720-0706
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4300
  • Fax: 559-459-4569
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMTL-2017-069
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A6702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: