Individual
MARK E FAHEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3334 CAPITAL MEDICAL BLVD, SUITE 400, TALLAHASSEE, FL 32308-4470
(850) 877-8174
(850) 877-5636
Mailing address
3334 CAPITAL MEDICAL BLVD, STE. 400, TALLAHASSEE, FL 32308-4470
(850) 877-8174
(850) 877-5636
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
039786
GA
207X00000X
Orthopaedic Surgery Physician
Primary
ME53578
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000500728C
—
GA
05
—
000500728D
—
GA
05
—
370237500
—
FL
Enumeration date
05/24/2005
Last updated
01/02/2013
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