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Individual
TIMOTHY D FAGEN
Active
Individual
TIMOTHY D FAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
2010014000
MO
208D00000X
General Practice Physician
5101017047
MI
208D00000X
General Practice Physician
DOS 1120
HI
Other
Enumeration date
07/11/2006
Last updated
08/11/2010
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