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General NPI Number Information
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NPI Number | 1730104498
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Entity Type | Organization
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Legal Business Name | EMERGENCY DEPARTMENT PHYSICIANS MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 1225 WILSHIRE BOULEVARD
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City | LOS ANGELES
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State | CA
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Zip | 90017-2395
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Country | US
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Telephone | 213-482-2741
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 NORTH HOLLYWOOD WAY SUITE 209
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City | BURBANK
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State | CA
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Zip | 91505-5015
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Country | US
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Telephone | 818-557-0135
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Fax | 818-557-1394
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP J FAGAN
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Credential | M.D.
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Telephone | 818-557-0135
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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 |
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License Number State |
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