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General NPI Number Information
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NPI Number | 1528139094
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Entity Type | Organization
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Legal Business Name | ANDREW J. FRAGEN, MD, FACS, INC.
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 555 E TACHEVAH DR SUITE 2E-101
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5750
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Country | US
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Telephone | 760-327-1885
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Fax | 760-327-1895
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Provider Business Mailing Address
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Address Line | 555 E TACHEVAH DR SUITE 2E-101
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5750
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Country | US
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Telephone | 760-327-1885
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Fax | 760-327-1895
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANDREW J FRAGEN
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Credential | M.D.
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Telephone | 760-327-1885
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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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