Provider Demographics
NPI:1003567447
Name:FANUCCHI, PAUL JOSEPH (NP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:FANUCCHI
Suffix:
Gender:M
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:MARIANIST RESIDENCE
Mailing Address - Street 2:520 FONDHAM
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-4821
Mailing Address - Country:US
Mailing Address - Phone:210-434-4157
Mailing Address - Fax:210-433-6005
Practice Address - Street 1:MARIANIST RESIDENCE
Practice Address - Street 2:520 FONDHAM
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-4821
Practice Address - Country:US
Practice Address - Phone:210-434-4157
Practice Address - Fax:210-433-6005
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP108274207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine