Healthcare Provider Details

I. General information

NPI: 1215028220
Provider Name (Legal Business Name): DAVID L. FAHRINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 GRANDE DR
PENSACOLA FL
32504-5935
US

IV. Provider business mailing address

4901 GRANDE DR
PENSACOLA FL
32504-5935
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-7042
  • Fax: 850-474-9060
Mailing address:
  • Phone: 850-477-7042
  • Fax: 850-474-9060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberME92740
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME92740
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME92740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: