Healthcare Provider Details

I. General information

NPI: 1316051782
Provider Name (Legal Business Name): JOSEPH STARR FAGNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W BOYD DR UNIT 915
ALLEN TX
75013-2678
US

IV. Provider business mailing address

304 W. BOYD DR. UNIT 915
ALLEN TX
75013-0980
US

V. Phone/Fax

Practice location:
  • Phone: 469-831-1839
  • Fax:
Mailing address:
  • Phone: 469-831-1839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK0464
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: