Healthcare Provider Details

I. General information

NPI: 1558359885
Provider Name (Legal Business Name): DAVID FICHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 PETALUMA AVE
SEBASTOPOL CA
95472-4217
US

IV. Provider business mailing address

678 PETALUMA AVE
SEBASTOPOL CA
95472-4217
US

V. Phone/Fax

Practice location:
  • Phone: 707-829-1811
  • Fax: 707-829-5593
Mailing address:
  • Phone: 707-829-1811
  • Fax: 707-829-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG56079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: