Provider Demographics
NPI:1457439192
Name:FUCHS, EDWARD S (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:FUCHS
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 1:6929 FAIR OAKS BLVD UNIT 1064
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95609-3541
Mailing Address - Country:US
Mailing Address - Phone:916-768-4443
Mailing Address - Fax:
Practice Address - Street 1:6045 GRANT AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3318
Practice Address - Country:US
Practice Address - Phone:916-768-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G402640Medicaid
00G402640Medicare ID - Type Unspecified
A48163Medicare UPIN