Provider Demographics
NPI:1861462640
Name:FIREK, ANTHONY FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:FRANCIS
Last Name:FIREK
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 1:1700 N WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-5105
Mailing Address - Country:US
Mailing Address - Phone:909-883-8611
Mailing Address - Fax:909-886-1798
Practice Address - Street 1:1700 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-5105
Practice Address - Country:US
Practice Address - Phone:909-883-8611
Practice Address - Fax:909-886-1798
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG559560207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G559560Medicaid
E32909Medicare UPIN
CA00G559560Medicare ID - Type Unspecified