Healthcare Provider Details

I. General information

NPI: 1154332575
Provider Name (Legal Business Name): ELIZABETH LOUISE FAGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 W UNIVERSITY DR
MCKINNEY TX
75071-7822
US

IV. Provider business mailing address

760 STINSON RD
ALLEN TX
75002-7312
US

V. Phone/Fax

Practice location:
  • Phone: 469-764-5059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberK5924
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: