Provider Demographics
NPI:1508262429
Name:MAYFAIR MEDICAL CARE PLLC
Entity Type:Organization
Organization Name:MAYFAIR MEDICAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MICHIELLE
Authorized Official - Middle Name:N
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-389-0855
Mailing Address - Street 1:1910 PACIFIC AVE
Mailing Address - Street 2:SUITE 15700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4529
Mailing Address - Country:US
Mailing Address - Phone:214-389-0855
Mailing Address - Fax:214-389-0859
Practice Address - Street 1:131 GLACIER LN
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1364
Practice Address - Country:US
Practice Address - Phone:214-389-0855
Practice Address - Fax:214-389-0859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4373207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty