MEDICARE: ROBERT M. FAY, M.D., MEDICAL CORPORATION

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	A68720	CA
2	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	A68720	CA
3	207T00000X	Neurological Surgery Physician	A68720	CA
4	207XS0106X	Orthopaedic Hand Surgery Physician	A68720	CA
5	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	A68720	CA
6	207XS0117X	Orthopaedic Surgery of the Spine Physician	A68720	CA
7	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	A68720	CA
8	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	A68720	CA
9	207XX0801X	Orthopaedic Trauma Physician	A68720	CA
10	208200000X	Plastic Surgery Physician	A68720	CA
11	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	A68720	CA
12	2082S0105X	Surgery of the Hand (Plastic Surgery) Physician	A68720	CA
13	2086S0102X	Surgical Critical Care Physician	A68720	CA
14	2086S0105X	Surgery of the Hand (Surgery) Physician	A68720	CA
15	207X00000X	Orthopaedic Surgery Physician	A68720	CA

General Provider Information

NPI Number	:	1275550154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT M. FAY, M.D., MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	79090 AVENUE 42 APT F101
Second Line	:
City	:	BERMUDA DUNES
State	:	CA
Zip	:	92203-7909
Country	:	US
Telephone Number	:	761-485-7402
Fax Number	:	760-775-2656

Provider Business Practice Location Address
First Line	:	3625 MARTIN LUTHER KING JR BLVD STE 9
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-3509
Country	:	US
Telephone Number	:	760-485-7402
Fax Number	:	760-775-2656

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT MICHAEL FAY
Credential	:	M.D.
Telephone Number	:	760-485-7402

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	06/17/2013

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