Individual
DR. JOHN ANDERSON FAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2901 MAPLEWOOD AVE, WINSTON-SALEM, NC 27103
(336) 765-8620
(336) 768-6236
Mailing address
2901 MAPLEWOOD AVE, WINSTON-SALEM, NC 27103
(336) 765-8620
(336) 768-6236
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
200001199779
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
240001710
RAILROAD MEDICARE
NC
01
—
31036
BCBS
NC
01
—
60623
MEDCOST
NC
05
—
8931036
—
NC
01
—
912
PARTNERS
NC
Enumeration date
05/04/2006
Last updated
12/17/2012
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