Provider Demographics
NPI:1386018356
Name:CAN EMERGENCY PHYSICIANS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:CAN EMERGENCY PHYSICIANS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:626-447-0296
Mailing Address - Street 1:PO BOX 845307
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-5307
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-623-1227
Practice Address - Street 1:14662 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6064
Practice Address - Country:US
Practice Address - Phone:714-619-7700
Practice Address - Fax:626-623-1227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty