Provider Demographics
NPI:1093757254
Name:FAIGIN, AL EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:AL
Middle Name:EDWARD
Last Name:FAIGIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5703 WESTCREEK
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133
Mailing Address - Country:US
Mailing Address - Phone:817-294-0731
Mailing Address - Fax:817-294-8065
Practice Address - Street 1:5703 WESTCREEK
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133
Practice Address - Country:US
Practice Address - Phone:817-294-0731
Practice Address - Fax:817-294-8065
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4836207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097333101Medicaid
A66300Medicare UPIN
8287K0Medicare ID - Type Unspecified