MEDICARE: HAROLD HUBBARD FAIN JR. 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	207Q00000X	Family Medicine Physician	16349	OK
2	207Q00000X	Family Medicine Physician	F6612	TX
3	2083P0901X	Public Health & General Preventive Medicine Physician	16349	OK
4	2083P0901X	Public Health & General Preventive Medicine Physician	F6612	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01193104	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	8DN674	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346239258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAROLD HUBBARD FAIN JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 99335
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76199-0335
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 MONTGOMERY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-2553
Country	:	US
Telephone Number	:	817-702-7400
Fax Number	:

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	09/17/2013

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