Provider Demographics
NPI:1740248467
Name:FEARING, OLIN KIRK (MD)
Entity type:Individual
Prefix:MR
First Name:OLIN
Middle Name:KIRK
Last Name:FEARING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 N. UNIVERSITY DR.
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965
Mailing Address - Country:US
Mailing Address - Phone:936-205-9922
Mailing Address - Fax:936-205-9923
Practice Address - Street 1:3618 N. UNIVERSITY DR.
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965
Practice Address - Country:US
Practice Address - Phone:936-205-9922
Practice Address - Fax:936-205-9923
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0435729-01Medicaid
TX84W962Medicare ID - Type Unspecified
TX0435729-01Medicaid