Bobbie Rae Faivus Vangorder, P.A.
Physician Assistant, Medical in Oswego, NY. Individual provider (NPI-1).
NPI number1154630366
StatusActive
Last updated in NPPESMar 29, 2023
Details
- NPI
- 1154630366
- Entity type
- Individual (NPI-1)
- Name
- Mrs. Bobbie Rae Faivus Vangorder
- Credential
- P.A.
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 5, 2010
- Certification date
- Mar 29, 2023
- Last updated
- Mar 29, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 014226 | NY | Yes |
Practice location
110 W Utica StOswego, NY 13126-3047
Phone 315-349-5537
Mailing address
110 W 6th StOswego, NY 13126-2507
Phone 315-349-5511 · Fax 315-349-5921
Other practice locations
1 College Plaza
Oswego, NY 13126-1731
Oswego, NY 13126-1731
Phone 315-342-0030 · Fax 315-342-0258
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