Healthcare Provider Details

I. General information

NPI: 1144405762
Provider Name (Legal Business Name): FAIRMONT PEDIATRICS AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4002 BURKE RD STE 200
PASADENA TX
77504-3451
US

IV. Provider business mailing address

4002 BURKE RD STE 200
PASADENA TX
77504-3451
US

V. Phone/Fax

Practice location:
  • Phone: 281-487-5437
  • Fax: 281-487-7054
Mailing address:
  • Phone: 281-487-5437
  • Fax: 281-487-7054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberJ9094
License Number StateTX

VIII. Authorized Official

Name: MR. JOE OCERA
Title or Position: PROVIDER RELATIONS
Credential:
Phone: 281-487-5437