Provider Demographics
NPI:1972505139
Name:FAWCETT, JAMES CAREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CAREY
Last Name:FAWCETT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3969 4TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3165
Mailing Address - Country:US
Mailing Address - Phone:619-260-0060
Mailing Address - Fax:619-260-0460
Practice Address - Street 1:3969 4TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3165
Practice Address - Country:US
Practice Address - Phone:619-260-0060
Practice Address - Fax:619-260-0460
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2016-10-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA35023208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49509Medicare UPIN