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1023129012

NPI Code Detail

MEDICARE: DR. FEN SARTORIUS M.D.

MEDICARE: DR. FEN SARTORIUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	79-266	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202014953	OTHER		PRESBYTERIAN HEALTH PLAN
2	10000283	OTHER		LOVELACE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1700291	OTHER		UHC
5	NM042528	OTHER	NM	BCBS NM
6	QMYPR0071765	OTHER		MOLINA

General Provider Information

NPI Number	:	1023129012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FEN SARTORIUS M.D.

Provider Business Mailing Address
First Line	:	4001 RODEO RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-4830
Country	:	US
Telephone Number	:	505-471-8994
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 RODEO RD
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-4830
Country	:	US
Telephone Number	:	505-471-8994
Fax Number	:	505-473-1274

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/27/2012

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Directions to “ DR. FEN SARTORIUS M.D.” Practice Location

Language	Start Address	Practice Location

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