Fagan, Philip J.
Fagan, Philip J. is an individual health care provider with primary practice located at 14642 Newport Ave Ste 101 , Tustin CA 92780-6058. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Fagan, Philip J. can be contacted via phone (714) 581-6470.Contact Information
Primary practice address
14642 Newport Ave Ste 101
Tustin CA 92780-6058
Phone: (714) 581-6470
Fax: (714) 581-6492
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | C32505 | California |
Allopathic & Osteopathic Physicians / Emergency Medicine | 207P00000X | C32505 | California |
Profile Details
NPI number | 1255335154 |
---|---|
LBN Legal business name | Fagan, Philip J. |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jun 8th, 2005 |
Last updated | Jan 23rd, 2024 - about 8 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1255335154 | NPPES |
California | Other | 00C325050 | BLUE SHIELD |
California | MEDICAID | 00C325050 | BLUE SHIELD |
California | Other | 00C325050 | BLUE SHIELD |
California | Other | 930085818 | BLUE SHIELD |
California | Other | C32505 | BLUE SHIELD |
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