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General NPI Number Information
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NPI Number | 1659494268
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Entity Type | Individual
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Provider Name | BENJAMIN FAGO MD
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Gender | Male
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 715 N SAINT JOSEPH AVE
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City | HASTINGS
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State | NE
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Zip | 68901-4451
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Country | US
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Telephone | 402-461-5122
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Fax |
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Provider Business Mailing Address
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Address Line | 715 N SAINT JOSEPH AVE
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City | HASTINGS
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State | NE
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Zip | 68901-4451
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Country | US
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Telephone |
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 23561
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License Number State | NE
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