Healthcare Provider Details

I. General information

NPI: 1801215512
Provider Name (Legal Business Name): BERRY FAIRCHILD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9230 KATY FWY STE 600
HOUSTON TX
77055-7468
US

IV. Provider business mailing address

9230 KATY FWY STE 600
HOUSTON TX
77055-7468
US

V. Phone/Fax

Practice location:
  • Phone: 713-489-5979
  • Fax: 713-512-2200
Mailing address:
  • Phone: 713-489-5979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberS3163
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: