Provider Demographics
NPI:1750550885
Name:DAVID FAIRWEATHER MD PA
Entity type:Organization
Organization Name:DAVID FAIRWEATHER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRWEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-453-8711
Mailing Address - Street 1:1140 WESTMONT DR
Mailing Address - Street 2:STE. 520
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-4363
Mailing Address - Country:US
Mailing Address - Phone:713-453-8711
Mailing Address - Fax:
Practice Address - Street 1:1140 WESTMONT DR
Practice Address - Street 2:STE. 520
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-4363
Practice Address - Country:US
Practice Address - Phone:713-453-8711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7373208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty