Provider Demographics
NPI:1700051422
Name:FAIN, JOHN WYTHE II (CPO)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WYTHE
Last Name:FAIN
Suffix:II
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7110 CECIL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4904
Mailing Address - Country:US
Mailing Address - Phone:713-799-1177
Mailing Address - Fax:713-796-8016
Practice Address - Street 1:7110 CECIL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4904
Practice Address - Country:US
Practice Address - Phone:713-799-1177
Practice Address - Fax:713-796-8016
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist