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
1	2085R0202X	Diagnostic Radiology Physician	A147451	CA
2	2085R0202X	Diagnostic Radiology Physician	MD187189	OR

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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