Provider Demographics
NPI:1750488276
Name:FEARMONTI, REGINA MARIE (MD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:FEARMONTI
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 1:11503 NW MILITARY HWY
Mailing Address - Street 2:STE 114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1884
Mailing Address - Country:US
Mailing Address - Phone:210-343-1089
Mailing Address - Fax:
Practice Address - Street 1:11503 NW MILITARY HWY
Practice Address - Street 2:STE 114
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1884
Practice Address - Country:US
Practice Address - Phone:210-343-1089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4776208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W4570OtherBCBS
TX184580202Medicaid
TX8W4570OtherBCBS