Provider Demographics
NPI:1831348192
Name:ROBERT H FAIN JR MD PA
Entity type:Organization
Organization Name:ROBERT H FAIN JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:713-796-2663
Mailing Address - Street 1:PO BOX 848310
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8310
Mailing Address - Country:US
Mailing Address - Phone:713-796-2663
Mailing Address - Fax:713-799-2663
Practice Address - Street 1:6400 FANNIN ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1521
Practice Address - Country:US
Practice Address - Phone:713-796-2663
Practice Address - Fax:713-799-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B22613Medicare UPIN