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Organization
MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Active
Organization
MERCED FACULTY ASSOCIATES MEDICAL GROUP INCORPORATED
Active
Other names
MFA Podiatry
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA SHAW (CEO)
(209) 723-1920
Entity
Organization
Contact information
Practice address
378 W OLIVE AVE STE C, MERCED, CA 95348-3137
(209) 384-3198
(209) 725-1603
Mailing address
PO BOX 3768, MERCED, CA 95344-3768
(209) 725-7149
(209) 726-0259
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
213EP1101X
Primary Podiatric Medicine Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1780882522
—
CA
01
—
CS1342
RAILROAD MEDICARE
GA
01
—
ZZZ69519Z
BLUE SHIELD GROUP
CA
Enumeration date
07/03/2007
Last updated
07/15/2014
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