MEDICARE: ANTHONY FAM, M.D., A PROFESSIONAL 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1881406999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTHONY FAM, M.D., A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1199 PACIFIC HWY UNIT 1606
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-8419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1665 UNION ST STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2906
Country	:	US
Telephone Number	:	619-663-5344
Fax Number	:	619-373-9206

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY FAM
Credential	:	M.D.
Telephone Number	:	619-663-5344

Provider Enumeration Date	:	01/24/2025
Last Update Date	:	01/28/2025

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