Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G13883 | CA |
N | 208200000X | Surgeon | G13883 | CA |
N | 208600000X | Surgeon | G13883 | CA |
NPI | 1043378409 |
---|---|
Provider Name | Arthur C Fenn |
First Address | Greenbrae, CA 94904-2133 |
Second Address | Greenbrae, CA 94904-2133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 01/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0040017876 | RAILROAD MCR (01) | CA |
00G138830 | (05) | CA |
A39108 | (02) |