Provider Demographics
NPI:1558397703
Name:FABRIZIO, GINGER HALL (PA)
Entity Type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:HALL
Last Name:FABRIZIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1680 ANTILLEY ROAD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5247
Mailing Address - Country:US
Mailing Address - Phone:325-428-5680
Mailing Address - Fax:325-428-5689
Practice Address - Street 1:2000 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2434
Practice Address - Country:US
Practice Address - Phone:325-673-0100
Practice Address - Fax:325-670-6172
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01599363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA01599OtherSTATE LICENSE
TX8D0340Medicare ID - Type UnspecifiedMEDICARE
TXPA01599OtherSTATE LICENSE