Individual
MARK ALLEN FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SA-C
Contact information
Practice address
408 GLENNWOOD, GLENN ROSE, TX 76043
(254) 897-1445
Mailing address
408 GLENNWOOD, P.O. BOX 3129, GLENN ROSE, TX 76043
(254) 897-1445
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
05-144
TX
Other
Enumeration date
01/09/2008
Last updated
01/09/2008
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