Individual
DR. JERRY DEAN FAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 W 38TH ST, SUITE 200, AUSTIN, TX 78705-1165
(512) 419-9733
(512) 451-3709
Mailing address
PO BOX 911230, DALLAS, TX 75391-1230
(972) 997-8000
(972) 234-0813
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
H4310
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131313202
—
TX
05
—
131313207
—
TX
05
—
131313208
—
TX
01
—
830004599
RAILROAD MEDICARE NUMBER
TX
01
—
8BP225
BCBS OF TX
TX
01
—
P00645999
RAILROAD MEDICARE
TX
Enumeration date
06/14/2006
Last updated
01/13/2009
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