Provider Demographics
NPI:1629060108
Name:FU, ERIC J (MD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:J
Last Name:FU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17213 CORIANDER CT
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6251
Mailing Address - Country:US
Mailing Address - Phone:714-646-9830
Mailing Address - Fax:714-646-9830
Practice Address - Street 1:17213 CORIANDER CT
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-6251
Practice Address - Country:US
Practice Address - Phone:714-646-9830
Practice Address - Fax:714-646-9830
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20494208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100062850AMedicaid
OK731532585001OtherBCBS
5509558OtherAETNA
OK100062850AMedicaid