MEDICARE: DENNIS FAIX MD, MPH

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	2083P0901X	Public Health & General Preventive Medicine Physician	39540020	WI

General Provider Information

NPI Number	:	1154308351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS FAIX MD, MPH

Provider Business Mailing Address
First Line	:	4894 EASTCLIFF CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2753
Country	:	US
Telephone Number	:	858-342-0872
Fax Number	:

Provider Business Practice Location Address
First Line	:	3235 ALBACORE ALY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92136-5199
Country	:	US
Telephone Number	:	619-556-7070
Fax Number	:

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	07/08/2007

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