MEDICARE: STEVEN WADE FATH 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	208600000X	Surgery Physician	K8144	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	:	1982661542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN WADE FATH M.D.

Provider Business Mailing Address
First Line	:	420 E 6TH ST STE 104
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-4537
Country	:	US
Telephone Number	:	432-333-8400
Fax Number	:	432-333-8401

Provider Business Practice Location Address
First Line	:	420 E 6TH ST STE 104
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-4537
Country	:	US
Telephone Number	:	432-333-8400
Fax Number	:	432-333-8401

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	08/26/2011

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