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General NPI Number Information
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NPI Number | 1417910092
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Entity Type | Individual
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Provider Name | ANDREW J FRAGEN MD, FACS
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Gender | Male
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 1180 N INDIAN CANYON DR SUITE E205
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City | PALM SPRINGS
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State | CA
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Zip | 92262-4800
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Country | US
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Telephone | 760-323-6322
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Fax |
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Provider Business Mailing Address
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Address Line | 1180 N INDIAN CANYON DR STE E421
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City | PALM SPRINGS
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State | CA
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Zip | 92262-4882
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Country | US
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Telephone | 760-424-8224
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Fax | 760-424-8227
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G83291
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License Number State | CA
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