Organization
EMERGENCY DEPARTMENT PHYSICIANS MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILIP J FAGAN M.D. (PRESIDENT)
(818) 557-0135
Entity
Organization
Contact information
Practice address
1225 WILSHIRE BOULEVARD, LOS ANGELES, CA 90017-2395
(213) 482-2741
Mailing address
2550 NORTH HOLLYWOOD WAY, SUITE 209, BURBANK, CA 91505-5015
(818) 557-0135
(818) 557-1394
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CC6638
GOOD SAM RAILROAD
CA
05
—
GR0014357
—
CA
01
—
ZZZ42800Z
GOOD SAM BLUE SHIELD
CA
Enumeration date
07/13/2006
Last updated
10/10/2008
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