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General NPI Number Information
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NPI Number | 1063588895
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Entity Type | Organization
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Legal Business Name | FAIRCHILD MEDICAL GROUP
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 475 BRUCE ST STE 500
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City | YREKA
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State | CA
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Zip | 96097-3463
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Country | US
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Telephone | 530-842-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 2107 LIVINGSTON ST SUITE A
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City | OAKLAND
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State | CA
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Zip | 94606-5218
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Country | US
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Telephone | 510-436-9000
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Fax | 510-436-9013
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN MARON
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Credential | MD
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Telephone | 510-436-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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