JAKE FAGAN, MD
Dermatology - MOHS-Micrographic Surgery
Active
Individual
NPI: 1548688989
Specialties
| Specialty | Code | Primary | License |
|---|---|---|---|
| Dermatology | 207N00000X | No | MED-PHYS-LIC-76211 (MT) |
| Dermatology - MOHS-Micrographic Surgery | 207ND0101X | Yes | 6845592-1205 (UT) |
| Surgery - Surgical Oncology | 2086X0206X | No | MED-PHYS-LIC-76211 (MT) |
| Student in an Organized Health Care Education/Training Program | 390200000X | No | - |
Frequently Asked Questions
NPI 1548688989 is the National Provider Identifier for JAKE FAGAN, MD, a Dermatology - MOHS-Micrographic Surgery provider located in Provo, UT. This NPI was enumerated on April 2, 2014.
JAKE FAGAN, MD practices at 1055 N 500 W # 111, Provo, UT 84604.
Quick Facts
- NPI
- 1548688989
- Type
- Individual
- Enumerated
- Apr 2, 2014
- Last Updated
- Apr 17, 2024
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