MEDICARE: DR. STEPHEN FAEHNLE 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	208000000X	Pediatrics Physician	F0997	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	86X081	OTHER	TX	BCBS
3	122441	OTHER	TX	CHIP
4	112460100	OTHER	TX	FIRSTCARE HMO

General Provider Information

NPI Number	:	1245240498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN FAEHNLE MD

Provider Business Mailing Address
First Line	:	1850 HICKORY ST
Second Line	:	SUITE #102
City	:	ABILENE
State	:	TX
Zip	:	79601-2334
Country	:	US
Telephone Number	:	325-677-2801
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 HICKORY ST
Second Line	:	SUITE #102
City	:	ABILENE
State	:	TX
Zip	:	79601-2334
Country	:	US
Telephone Number	:	325-677-2801
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	05/02/2008

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