Provider Demographics
NPI:1285629600
Name:FAIRCHILD, ROBERT LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEO
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3945
Mailing Address - Street 2:DEPT 841
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77253-3945
Mailing Address - Country:US
Mailing Address - Phone:281-358-8114
Mailing Address - Fax:281-358-0609
Practice Address - Street 1:4000 SPENCER HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1202
Practice Address - Country:US
Practice Address - Phone:713-359-2000
Practice Address - Fax:713-359-1004
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1956207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050067148OtherRR MCR
TX82174FOtherBCBS
TX8G2770OtherBC/BS
TX122929601Medicaid
TX050090438OtherRAILROAD MEDICARE
TX122929606Medicaid
TX82174FMedicare PIN
TX82174FOtherBCBS
TXX0066687OtherDPS
BF1017121OtherDEA
TX8A1419Medicare ID - Type Unspecified