Healthcare Provider Details

I. General information

NPI: 1285745521
Provider Name (Legal Business Name): LELAND THOMAS FIFE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 E 13TH ST
MERCED CA
95340-6242
US

IV. Provider business mailing address

PO BOX 3768
MERCED CA
95344-3768
US

V. Phone/Fax

Practice location:
  • Phone: 209-383-3381
  • Fax: 209-722-2025
Mailing address:
  • Phone: 209-383-3381
  • Fax: 209-722-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA24764
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA24764
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA24764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: