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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 4 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.

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Identifiers

StateTypeNumberIssuer
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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