Provider Demographics
NPI:1457586141
Name:FAIRCHILD, TAMMY LYNN (MD)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:FAIRCHILD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 122431
Mailing Address - Street 2:DEPT 2431
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2431
Mailing Address - Country:US
Mailing Address - Phone:337-480-8900
Mailing Address - Fax:337-480-8901
Practice Address - Street 1:4501 NELSON RD BLDG A
Practice Address - Street 2:SUITE 4
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5207
Practice Address - Country:US
Practice Address - Phone:832-419-8026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-25
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP1-0034753207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology