Provider Demographics
NPI:1063496503
Name:FEFER, LOREN ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:ALEXANDER
Last Name:FEFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W RANCH VIEW DR STE 2005
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5391
Mailing Address - Country:US
Mailing Address - Phone:916-295-5700
Mailing Address - Fax:
Practice Address - Street 1:550 W RANCH VIEW DR STE 2005
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5391
Practice Address - Country:US
Practice Address - Phone:916-295-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA045094207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A450940Medicaid
CAF25422Medicare UPIN
CA00A450940Medicaid