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General NPI Number Information
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NPI Number | 1508115718
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Entity Type | Organization
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Legal Business Name | FAIRWAY FAMILY MEDICINE-PRIMARY CARE, PLLC
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 4100 FAIRWAY DR 320
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City | CARROLLTON
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State | TX
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Zip | 75010-6525
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Country | US
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Telephone | 972-236-7608
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Fax |
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Provider Business Mailing Address
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Address Line | 4100 FAIRWAY DR 320
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City | CARROLLTON
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State | TX
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Zip | 75010-6525
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Country | US
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Telephone | 972-236-7608
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HONG XIAO
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Credential | M.D.
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Telephone | 469-878-9480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | L3196
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License Number State | TX
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