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General NPI Number Information
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NPI Number | 1073747663
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Entity Type | Individual
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Provider Name | TIM FIFE MD
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Gender | Male
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Dates
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Enumeration Date | 05/11/2009
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 2 MEDICAL PLAZA DR SUITE 225
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City | ROSEVILLE
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State | CA
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Zip | 95661-3043
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Country | US
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Telephone | 916-782-1291
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Fax | 916-782-5992
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Provider Business Mailing Address
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Address Line | 1111 EXPOSITION BLVD BUILDING 700
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City | SACRAMENTO
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State | CA
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Zip | 95815-4314
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Country | US
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Telephone | 916-736-3399
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Fax | 916-736-3350
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | A130563
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License Number State | CA
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