Provider Demographics
NPI:1679714174
Name:ARTHUR C. FENN & ROMEO C. AGBAYANI MD PTR
Entity type:Organization
Organization Name:ARTHUR C. FENN & ROMEO C. AGBAYANI MD PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:C
Authorized Official - Last Name:AGBAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-461-9773
Mailing Address - Street 1:1000 S ELISEO DR STE 103
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2150
Mailing Address - Country:US
Mailing Address - Phone:415-461-9773
Mailing Address - Fax:415-461-6744
Practice Address - Street 1:1000 S ELISEO DR STE 103
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2150
Practice Address - Country:US
Practice Address - Phone:415-461-9773
Practice Address - Fax:415-461-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty