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Organization
PETER G FAGAN MD PA
Active
Organization
PETER G FAGAN MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER G FAGAN M.D. (SOLE PROPRIETOR)
(254) 879-4910
Entity
Organization
Contact information
Practice address
10201 HIGHWAY 16, COMANCHE, TX 76442-4462
(254) 879-4900
(254) 879-4989
Mailing address
PO BOX 488, DE LEON, TX 76444-0488
(254) 893-4099
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
C15552
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8F23579
MC INDIVIDUAL
—
Enumeration date
12/21/2006
Last updated
02/11/2010
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