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General NPI Number Information
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NPI Number | 1649203605
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Entity Type | Organization
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Legal Business Name | FAIR OAKS EMERGENCY PHYSICIANS, PLLC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 3600 JOSEPH SIEWICK DR
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City | FAIRFAX
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State | VA
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Zip | 22033-1709
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Country | US
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Telephone | 703-391-3996
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Fax | 703-391-3094
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Provider Business Mailing Address
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Address Line | PO BOX 734980
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City | CHICAGO
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State | IL
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Zip | 60673-4980
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Country | US
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Telephone | 703-631-1745
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Fax | 703-662-4803
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Authorized Official
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Title or Position | GROUP HEAD
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Name | MR. JOHN JONES
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Credential | MD
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Telephone | 571-239-0788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number |
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License Number State | VA
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