Individual
ASHLEY JANAE FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1280 S MAIN ST STE 100, GRAPEVINE, TX 76051-7509
(817) 310-0898
(817) 310-5524
Mailing address
1280 S MAIN ST STE 100, GRAPEVINE, TX 76051-7509
(817) 310-0898
(817) 310-5524
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
N7802
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
323095501
—
TX
Enumeration date
07/27/2010
Last updated
04/07/2015
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