Provider Demographics
NPI:1508867680
Name:FACELLO, JAMES A (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:FACELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:815 S WASHINGTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-5369
Mailing Address - Country:US
Mailing Address - Phone:903-927-6800
Mailing Address - Fax:903-935-0617
Practice Address - Street 1:815 S WASHINGTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-5369
Practice Address - Country:US
Practice Address - Phone:903-927-6800
Practice Address - Fax:903-935-0617
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK3723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX813605Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE
TXG24696Medicare UPIN