MEDICARE: DR. KARANA R. FAIRLEY M.D.

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	207Q00000X	Family Medicine Physician	L0160	TX
2	173000000X	Legal Medicine	L0160	TX

General Provider Information

NPI Number	:	1194771006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARANA R. FAIRLEY M.D.

Provider Business Mailing Address
First Line	:	3105 W 15TH ST
Second Line	:	SUITE B
City	:	PLANO
State	:	TX
Zip	:	75075-7700
Country	:	US
Telephone Number	:	972-612-6900
Fax Number	:	972-612-6934

Provider Business Practice Location Address
First Line	:	3105 W 15TH ST
Second Line	:	SUITE B
City	:	PLANO
State	:	TX
Zip	:	75075-7700
Country	:	US
Telephone Number	:	972-612-6900
Fax Number	:	972-612-6934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/25/2014

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