MEDICARE: STEVEN W FATH MD

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	174400000X	Specialist	K8144	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0048HZ	OTHER	TX	BLUE CROSS
2	0048HZ	OTHER	TX	BLUE CROSS GROUP

General Provider Information

NPI Number	:	1235399858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEVEN W FATH MD

Provider Business Mailing Address
First Line	:	1346 E WALNUT ST
Second Line	:
City	:	SEGUIN
State	:	TX
Zip	:	78155-5126
Country	:	US
Telephone Number	:	830-303-8600
Fax Number	:	830-303-8601

Provider Business Practice Location Address
First Line	:	1346 E WALNUT ST
Second Line	:
City	:	SEGUIN
State	:	TX
Zip	:	78155-5126
Country	:	US
Telephone Number	:	830-303-8600
Fax Number	:	830-303-8601

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. LETICIA CANTU
Credential	:
Telephone Number	:	210-733-1802

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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Directions to “STEVEN W FATH MD ” Practice Location

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