Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | A68720 | CA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | A68720 | CA |
N | 207T00000X | Neurosurgeon | A68720 | CA |
Y | 207X00000X | Orthopaedic Surgeon | A68720 | CA |
N | 207XS0106X | Orthopaedic Hand Surgeon | A68720 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | A68720 | CA |
N | 207XS0117X | Orthopaedic Spine Surgeon | A68720 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A68720 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A68720 | CA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | A68720 | CA |
N | 208200000X | Surgeon | A68720 | CA |
N | 208600000X | Surgeon | A68720 | CA |
N | 2082S0105X | Plastic Hand Surgeon | A68720 | CA |
N | 2086S0102X | Surgical Critical Care | A68720 | CA |
N | 2086S0127X | Trauma Surgeon | A68720 | CA |
NPI | 1609803287 |
---|---|
Provider Name | Dr. Robert Michael Fay |
First Address | La Quinta, CA 92247-0839 |
Second Address | La Quinta, CA 92253-3175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 05/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H55079 | (02) |