Healthcare Provider Details

I. General information

NPI: 1417227802
Provider Name (Legal Business Name): ALEXIS D FURZE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16300 SAND CANYON AVE SUITE 201
IRVINE CA
92618-3711
US

IV. Provider business mailing address

PO BOX 1275
NEWPORT BEACH CA
92659
US

V. Phone/Fax

Practice location:
  • Phone: 949-727-1818
  • Fax: 949-727-1819
Mailing address:
  • Phone: 800-498-3223
  • Fax: 949-945-0479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA110385
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA110385
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA110385
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberA110385
License Number StateCA

VIII. Authorized Official

Name: ALEXIS D FURZE
Title or Position: PRESIDENT
Credential: MD
Phone: 800-498-3223