Individual
RAYMOND A FAIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1325 PENNSYLVANIA AVE, SUITE 325, FORT WORTH, TX 76104-2175
(817) 878-5325
(817) 332-2372
Mailing address
PO BOX 961205, FORT WORTH, TX 76161-1205
(817) 740-8400
(817) 332-2372
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
E6342
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130279607
—
TX
01
—
240008035
RAILROAD MEDICARE
—
Enumeration date
07/17/2006
Last updated
09/30/2011
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