Individual
JADEN HEBER FACKRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3601 4TH ST, LUBBOCK, TX 79430-0002
(806) 743-6144
Mailing address
3601 4TH ST, LUBBOCK, TX 79430-0002
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
136115531205
UT
207L00000X
Anesthesiology Physician
Primary
U6714
TX
Other
Enumeration date
05/29/2019
Last updated
11/06/2024
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