Organization
JOHN M. FACKLER M.D. PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN M FACKLER M.D. PA (PRESIDENT/OWNER)
(936) 539-2663
Entity
Organization
Contact information
Practice address
1501 RIVER POINTE DR, SUITE 100, CONROE, TX 77304-2656
(936) 539-2663
(936) 539-2664
Mailing address
1501 RIVER POINTE DR, SUITE 100, CONROE, TX 77304-2656
(936) 539-2663
(936) 539-2664
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
K2687
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
031123501
—
TX
Enumeration date
08/26/2011
Last updated
02/07/2014
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