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Individual

JONATHAN BRETT FUGITT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1100 MARSHALL WAY, MARSHALL MEDICAL CENTER, PLACERVILLE, CA 95667
(530) 626-2774
(509) 248-0178
Mailing address
681 MAIN STREET, STE 105, PLACERVILLE, CA 95667
(530) 626-1166
(530) 626-3826

Taxonomy

Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
A85990
CA
2085N0700X
Neuroradiology Physician
A85992
CA
2085R0202X
Diagnostic Radiology Physician
Primary
A85990
CA
2085R0202X
Diagnostic Radiology Physician
MD60491574
WA
2085U0001X
Diagnostic Ultrasound Physician
A85990
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GR0053460
CA
Enumeration date
01/28/2006
Last updated
12/27/2016
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