Provider Demographics
NPI:1023129012
Name:SARTORIUS, FEN (MD)
Entity type:Individual
Prefix:DR
First Name:FEN
Middle Name:
Last Name:SARTORIUS
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 1:4001 RODEO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4830
Mailing Address - Country:US
Mailing Address - Phone:505-471-8994
Mailing Address - Fax:
Practice Address - Street 1:4001 RODEO RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4830
Practice Address - Country:US
Practice Address - Phone:505-471-8994
Practice Address - Fax:505-473-1274
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM79-266207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
202014953OtherPRESBYTERIAN HEALTH PLAN
10000283OtherLOVELACE
NM32821Medicaid
1700291OtherUHC
NMNM042528OtherBCBS NM
QMYPR0071765OtherMOLINA
NM346704502Medicare PIN
QMYPR0071765OtherMOLINA