Individual
DR. SETH ALFRED FAGERLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5102 W CAMPBELL AVE, PHOENIX, AZ 85031-1703
(623) 848-5000
Mailing address
26078 N 71ST DR, PEORIA, AZ 85383-7318
(623) 362-3733
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
33539
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39-81220
EVERCARE GROUP
AZ
05
—
936239
—
AZ
01
—
AW1436
HEALTHNET GROUP
AZ
01
—
AZ0728670
BLUE CROSS/BLUE SHIELD GR
AZ
Enumeration date
11/07/2005
Last updated
11/12/2007
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