Provider Demographics
NPI:1174511281
Name:FAIN, KEVIN LEE (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LEE
Last Name:FAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1123 S PALESTINE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3646
Mailing Address - Country:US
Mailing Address - Phone:903-675-9526
Mailing Address - Fax:903-677-1815
Practice Address - Street 1:1123 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3646
Practice Address - Country:US
Practice Address - Phone:903-675-9526
Practice Address - Fax:903-677-1815
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3878207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8948K0OtherBLUE CROSS BLUE SHIELD
200039355OtherRAILROAD MEDICARE
TX131305806Medicaid
TX8948K0OtherBLUE CROSS BLUE SHIELD
TX131305806Medicaid
TX8948K0Medicare PIN