Fahey, Mark R.

Fahey, Mark R. is an individual health care provider with primary practice located at 401 Bicentennial Way , Santa Rosa CA 95403-2149. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Fahey, Mark R. can be contacted via phone (707) 571-4000.

Contact Information

Primary practice address
401 Bicentennial Way Santa Rosa CA 95403-2149
Phone: (707) 571-4000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X G38339 California

Profile Details

NPI number 1184708174
LBN Legal business name Fahey, Mark R.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 25th, 2006
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184708174 NPPES
California MEDICAID 00G383390

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