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NPI Code Detail

MEDICARE: DR. JILL SARA FAY M.D.

MEDICARE:  DR. JILL SARA FAY  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
12085R0202XDiagnostic Radiology PhysicianA147451CA
22085R0202XDiagnostic Radiology PhysicianMD187189OR

General Provider Information

NPI Number : 1063771889
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JILL SARA FAY M.D.
Provider Business Mailing Address
First Line : 2613 ALMOND ST
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601-1116
Country : US
Telephone Number : 541-851-9396
Fax Number : 541-851-9399
Provider Business Practice Location Address
First Line : 2613 ALMOND ST
Second Line :
City : KLAMATH FALLS
State : OR
Zip : 97601
Country : US
Telephone Number : 541-851-9396
Fax Number : 541-851-9399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2012
Last Update Date : 08/01/2018

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Directions to “ DR. JILL SARA FAY M.D.” Practice Location

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