Healthcare Provider Details

I. General information

NPI: 1003940388
Provider Name (Legal Business Name): FAGADAU & HAWK, M.D LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6131 LUTHER LN STE 216
DALLAS TX
75225
US

IV. Provider business mailing address

6131 LUTHER LN STE 216
DALLAS TX
75225
US

V. Phone/Fax

Practice location:
  • Phone: 214-987-2020
  • Fax: 214-739-3725
Mailing address:
  • Phone: 214-987-2020
  • Fax: 214-739-3725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateTX

VIII. Authorized Official

Name: MS. KATHLEEN A DAVIS
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 214-987-2020