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NPI Code Detail

MEDICARE: DR. MATT DOUGLAS FAY M.D.

MEDICARE:  DR. MATT DOUGLAS FAY  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RI0011XInterventional Cardiology PhysicianQ4579TX

General Provider Information

NPI Number : 1467613067
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MATT DOUGLAS FAY M.D.
Provider Business Mailing Address
First Line : 4650 LAKE RIDGE PARKWAY
Second Line : SUITE 300
City : GRAND PRAIRIE
State : TX
Zip : 75052-1908
Country : US
Telephone Number : 817-398-4300
Fax Number : 817-398-4301
Provider Business Practice Location Address
First Line : 6035 PRECINCT LINE RD
Second Line :
City : NORTH RICHLAND HILLS
State : TX
Zip : 76180-5410
Country : US
Telephone Number : 817-398-4300
Fax Number : 817-398-4301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2008
Last Update Date : 12/20/2022

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Directions to “ DR. MATT DOUGLAS FAY M.D.” Practice Location

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