Provider Demographics
NPI:1881669091
Name:PAUL T FASS M.D., P.A.
Entity Type:Organization
Organization Name:PAUL T FASS M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:FASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-933-9953
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33008-0729
Mailing Address - Country:US
Mailing Address - Phone:305-503-6320
Mailing Address - Fax:305-503-6329
Practice Address - Street 1:2999 NE 191ST ST
Practice Address - Street 2:SUITE 230
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3123
Practice Address - Country:US
Practice Address - Phone:305-933-9953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME15036207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty