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General NPI Number Information
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NPI Number | 1184904765
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Entity Type | Organization
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Legal Business Name | JOHN M. FACKLER M.D. PA
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 02/07/2014
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Provider Practice Location Address
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Address Line | 1501 RIVER POINTE DR SUITE 100
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City | CONROE
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State | TX
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Zip | 77304-2656
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Country | US
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Telephone | 936-539-2663
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Fax | 936-539-2664
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Provider Business Mailing Address
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Address Line | 1501 RIVER POINTE DR SUITE 100
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City | CONROE
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State | TX
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Zip | 77304-2656
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Country | US
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Telephone | 936-539-2663
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Fax | 936-539-2664
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JOHN M FACKLER
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Credential | M.D. PA
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Telephone | 936-539-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | K2687
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License Number State | TX
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