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General NPI Number Information
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NPI Number | 1073014114
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Entity Type | Organization
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Legal Business Name | FAIRVIEW DERMATOLOGY PLLC
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Dates
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Enumeration Date | 02/23/2018
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 331 TOWN PL
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City | FAIRVIEW
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State | TX
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Zip | 75069-1825
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Country | US
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Telephone | 972-747-0000
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Fax | 972-736-4020
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Provider Business Mailing Address
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Address Line | 331 TOWN PL
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City | FAIRVIEW
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State | TX
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Zip | 75069-1825
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Country | US
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Telephone | 972-747-0000
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Fax | 972-736-4020
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ANDREW HUDSON
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Credential | MD
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Telephone | 806-570-5338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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