MEDICARE: ROBERT YATES FASELER D.O.

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	H0337	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

General Provider Information

NPI Number	:	1871592006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT YATES FASELER D.O.

Provider Business Mailing Address
First Line	:	882 SIERRA DR
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5607
Country	:	US
Telephone Number	:	409-722-1234
Fax Number	:	409-722-3270

Provider Business Practice Location Address
First Line	:	882 SIERRA DR
Second Line	:
City	:	PORT NECHES
State	:	TX
Zip	:	77651-5607
Country	:	US
Telephone Number	:	409-722-1234
Fax Number	:	409-722-3270

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

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	03/29/2012

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