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Organization
FAGAN ER MEDICAL GROUP INC
Active
Organization
FAGAN ER MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP J. FAGAN JR. M.D. (PRESIDENT)
(818) 557-0135
Entity
Organization
Contact information
Practice address
1225 WILSHIRE BOULEVARD, LOS ANGELES, CA 90017-2395
(213) 482-2741
Mailing address
520 N CENTRAL AVE, SUITE 750, GLENDALE, CA 91203-1926
(818) 557-0135
(818) 557-1394
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC6682
GOOD SAM RAILROAD
CA
05
—
GR0048650
—
CA
01
—
ZZZ43319Z
GOOD SAM BLUE SHIELD
CA
Enumeration date
07/13/2006
Last updated
12/13/2010
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