MEDICARE: FAIRMONT PEDIATRICS AND ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	J9094	TX

General Provider Information

NPI Number	:	1144405762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRMONT PEDIATRICS AND ASSOCIATES

Provider Business Mailing Address
First Line	:	4002 BURKE RD STE 200
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-3451
Country	:	US
Telephone Number	:	281-487-5437
Fax Number	:	281-487-7054

Provider Business Practice Location Address
First Line	:	4002 BURKE RD STE 200
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-3451
Country	:	US
Telephone Number	:	281-487-5437
Fax Number	:	281-487-7054

Authorized Official
Title or Position	:	PROVIDER RELATIONS
Name	:	MR. JOE OCERA
Credential	:
Telephone Number	:	281-487-5437

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	11/22/2019

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