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Organization
FAIRCHILD MEDICAL GROUP
Active
Organization
FAIRCHILD MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN MARON MD (PRESIDENT)
(510) 436-9000
Entity
Organization
Contact information
Practice address
475 BRUCE ST STE 500, YREKA, CA 96097-3463
(530) 842-3507
Mailing address
2107 LIVINGSTON ST, SUITE A, OAKLAND, CA 94606-5218
(510) 436-9000
(510) 436-9013
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0089870
—
CA
05
—
RHM53972F
—
CA
01
—
ZZZ03208Z
BLUE SHIELD OF CALIFORNIA
CA
Enumeration date
11/24/2006
Last updated
03/12/2008
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