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General NPI Number Information
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NPI Number | 1962592097
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Entity Type | Individual
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Provider Name | MICHAEL J FAIRSHTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/05/2017
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Provider Practice Location Address
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Address Line | 320 1ST ST
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City | MARYSVILLE
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State | CA
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Zip | 95901-6023
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Country | US
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Telephone | 530-743-6531
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Fax | 530-743-7791
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Provider Business Mailing Address
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Address Line | 320 1ST STREET
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City | MARYSVILLE
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State | CA
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Zip | 95901-6023
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Country | US
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Telephone | 530-743-6531
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Fax | 530-743-7791
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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 | G35056
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License Number State | CA
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