Healthcare Provider Details

I. General information

NPI: 1003808338
Provider Name (Legal Business Name): RAYMOND FAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 CLAY ST #505
SAN FRANCISCO CA
94108-1556
US

IV. Provider business mailing address

929 CLAY ST #505
SAN FRANCISCO CA
94108-1556
US

V. Phone/Fax

Practice location:
  • Phone: 415-392-9690
  • Fax: 415-392-9695
Mailing address:
  • Phone: 415-392-9690
  • Fax: 415-392-9695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA22812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: