Provider Demographics
NPI:1972652287
Name:FGF NETWORK
Entity Type:Organization
Organization Name:FGF NETWORK
Other - Org Name:FAM PRACTICE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FATHI
Authorized Official - Middle Name:G
Authorized Official - Last Name:FAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-380-1510
Mailing Address - Street 1:17950 PRESTON RD
Mailing Address - Street 2:STE 210
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5793
Mailing Address - Country:US
Mailing Address - Phone:972-380-1510
Mailing Address - Fax:972-380-1539
Practice Address - Street 1:17950 PRESTON RD
Practice Address - Street 2:STE 210
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5793
Practice Address - Country:US
Practice Address - Phone:972-380-1510
Practice Address - Fax:972-380-1539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7909207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12777755006Medicaid
TX8F2042Medicare ID - Type UnspecifiedGROUP ID NUMBER
TX00984ZMedicare ID - Type UnspecifiedPROVIDER ID NUMBER