Individual
THOMAS FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9300 VALLEY CHILDRENS PL # SC05, MADERA, CA 93636-8761
(559) 353-5700
(559) 353-5708
Mailing address
9300 VALLEY CHILDRENS PL # SC05, MADERA, CA 93636-8761
(559) 353-5700
(559) 353-5708
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
44826
CO
2080P0202X
Pediatric Cardiology Physician
53605
TN
2080P0202X
Pediatric Cardiology Physician
Primary
G174751
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30488001
—
CO
Enumeration date
10/03/2005
Last updated
12/15/2021
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