Provider Demographics
NPI:1184748022
Name:FAIN, BECKY ANN (MD)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:ANN
Last Name:FAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 REGENTS PARK
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6843
Mailing Address - Country:US
Mailing Address - Phone:512-327-5785
Mailing Address - Fax:512-327-5786
Practice Address - Street 1:2705 REGENTS PARK
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6843
Practice Address - Country:US
Practice Address - Phone:512-327-5785
Practice Address - Fax:512-327-5786
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6204225400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX532970YKYCMedicare PIN
TX532970YK4EMedicare PIN