Fanning, Paul M
Fanning, Paul M is an individual health care provider with primary practice located at 1720 S Beckham Ave Ste 104 , Tyler TX 75701-4464. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Fanning, Paul M can be contacted via phone (903) 597-2002.Contact Information
Primary practice address
1720 S Beckham Ave Ste 104
Tyler TX 75701-4464
Phone: (903) 597-2002
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | J6425 | Texas |
Profile Details
| NPI number | 1972577419 |
|---|---|
| LBN Legal business name | Fanning, Paul M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 13th, 2006 |
| Last updated | Jul 21st, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972577419 | NPPES |
| Texas | MEDICAID | 1972577419 | |
| Texas | Other | 123074 | |
| Texas | Other | 75-2616977-136 | |
| Texas | MEDICAID | 129809306 | |
| Texas | Other | 45-2578435-002 | |
| Texas | Other | 83Y684 | |
| Texas | Other | 5623482 | |
| Texas | Other | P01572864 | |
| Texas | Other | 752616977022 | |
| Texas | Other | 8FM313 | |
| Texas | MEDICAID | 129809302 |
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