Provider Demographics
NPI:1174562060
Name:DAVID FAIRWEATHER, M.D., P.A.
Entity type:Organization
Organization Name:DAVID FAIRWEATHER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAIRWEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-831-9877
Mailing Address - Street 1:1140 WESTMONT DR
Mailing Address - Street 2:SUITE 520
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4363
Mailing Address - Country:US
Mailing Address - Phone:713-453-8711
Mailing Address - Fax:713-453-8721
Practice Address - Street 1:13920 OSPREY CT STE C
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1615
Practice Address - Country:US
Practice Address - Phone:832-831-9877
Practice Address - Fax:832-240-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160563602Medicaid
TX160563602Medicaid