Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | A130563 | CA |
NPI | 1073747663 |
---|---|
Provider Name | Tim Fife |
First Address | Sacramento, CA 95815-4314 |
Second Address | Roseville, CA 95661-3043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2009 |
Last Update Date | 07/03/2017 |