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Individual

JOHN M FACKLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
17183 INTERSTATE 45 S, SUITE 210, SHENANDOAH, TX 77385-3312
(936) 321-8000
(936) 271-0122
Mailing address
17183 INTERSTATE 45 S STE 210, SHENANDOAH, TX 77385-3313
(936) 321-8000
(936) 271-0122

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
05
031123502
TX
05
031123503
TX
01
8FB144
BLUE CROSS BLUE SHIELD
TX
01
8FX417
BCBS
TX
01
P01570351
RR MEDICARE
TX
01
P01725660
RR MEDICARE
TX
Enumeration date
08/18/2005
Last updated
05/06/2026
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