Provider Demographics
NPI:1144405762
Name:FAIRMONT PEDIATRICS AND ASSOCIATES
Entity Type:Organization
Organization Name:FAIRMONT PEDIATRICS AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:OCERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-487-5437
Mailing Address - Street 1:4002 BURKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-3451
Mailing Address - Country:US
Mailing Address - Phone:281-487-5437
Mailing Address - Fax:281-487-7054
Practice Address - Street 1:4002 BURKE RD STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-3451
Practice Address - Country:US
Practice Address - Phone:281-487-5437
Practice Address - Fax:281-487-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9094208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty