Healthcare Provider Details

I. General information

NPI: 1447495585
Provider Name (Legal Business Name): SCOTT FAGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7460 WARREN PKWY STE 100
FRISCO TX
75034-4170
US

IV. Provider business mailing address

7460 WARREN PKWY STE 100
FRISCO TX
75034-4170
US

V. Phone/Fax

Practice location:
  • Phone: 496-287-7825
  • Fax:
Mailing address:
  • Phone:
  • Fax: 800-514-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21413
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD. 202440
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberR5388
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: