Provider Demographics
NPI:1336415801
Name:FACQUE, ALEXANDER RHODES
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:RHODES
Last Name:FACQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SUTTER ST RM 1000
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-3913
Mailing Address - Country:US
Mailing Address - Phone:415-398-7778
Mailing Address - Fax:
Practice Address - Street 1:450 SUTTER ST RM 1000
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-3913
Practice Address - Country:US
Practice Address - Phone:415-398-7778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1616372086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery