Provider Demographics
NPI:1457387482
Name:FIELDS, GEORGE EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:EDWARD
Last Name:FIELDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 W. SUNFLOWER AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6948
Mailing Address - Country:US
Mailing Address - Phone:714-619-8777
Mailing Address - Fax:714-619-8770
Practice Address - Street 1:3401 W. SUNFLOWER AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6948
Practice Address - Country:US
Practice Address - Phone:714-619-8777
Practice Address - Fax:714-619-8770
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1207207Q00000X
CA20A4941207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX49410Medicaid
CA00AX49410Medicaid
CAW20A4941EMedicare ID - Type UnspecifiedGN MEDICAL