Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 062501 | GA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 062501 | GA |
NPI | 1326206459 |
---|---|
Provider Name | Reginald Scott Fayssoux |
First Address | Rancho Mirage, CA 92270-1059 |
Second Address | Rancho Mirage, CA 92270-3221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 15/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A11590 | CA LICENSE (01) | CA |