Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DN25227 | FL |
NPI | 1013529296 |
---|---|
Provider Name | Matthew B Fay |
First Address | Mobile, AL 36609-5401 |
Second Address | Mobile, AL 36609-5401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2020 |
Last Update Date | 19/08/2020 |