Provider Demographics
NPI:1710236252
Name:FAYRWEATHER, REID ARTHUR
Entity Type:Individual
Prefix:
First Name:REID
Middle Name:ARTHUR
Last Name:FAYRWEATHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2737
Mailing Address - Country:US
Mailing Address - Phone:713-932-5724
Mailing Address - Fax:
Practice Address - Street 1:1140 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2737
Practice Address - Country:US
Practice Address - Phone:713-932-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122283363LF0000X
TX661453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily