Healthcare Provider Details

I. General information

NPI: 1467276774
Provider Name (Legal Business Name): FAIRMONT FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W FAIRMONT PKWY STE B
LA PORTE TX
77571-6308
US

IV. Provider business mailing address

400 W FAIRMONT PKWY STE B
LA PORTE TX
77571-6308
US

V. Phone/Fax

Practice location:
  • Phone: 346-222-7370
  • Fax: 281-487-7054
Mailing address:
  • Phone: 346-222-7370
  • Fax: 281-487-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHU SYAL
Title or Position: OWNER & PHYSICIAN
Credential: MD
Phone: 346-222-7370