Individual
GORDON THOMAS FAHEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
999 S FAIRMONT AVE, SUITE 100, LODI, CA 95240-5100
(209) 334-2010
(209) 334-0132
Mailing address
999 S FAIRMONT AVE, SUITE 100, LODI, CA 95240-5100
(209) 334-2010
(209) 334-0132
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A78020
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0102080
—
CA
Enumeration date
02/03/2006
Last updated
05/02/2022
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