Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | A22812 | CA |
NPI | 1003808338 |
---|---|
Provider Name | Raymond Fay |
First Address | San Francisco, CA 94108-1556 |
Second Address | San Francisco, CA 94108-1556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2005 |
Last Update Date | 11/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2080416 | (05) | CA |
A23249 | (02) |