Individual
FANG S DAVID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1300 W TERRELL AVE FL 2, FORT WORTH, TX 76104-2820
(817) 820-4906
(817) 820-4815
Mailing address
1300 W TERRELL AVE FL 2, FORT WORTH, TX 76104-2820
(817) 820-4906
(817) 820-4815
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L6854
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161072702
—
TX
05
—
161072703
—
TX
05
—
161072704
—
TX
05
—
161072705
—
TX
05
—
161072706
—
TX
01
—
8B5307
BCBS
TN
01
—
P00126810
RR MEDICARE
TX
Enumeration date
07/13/2006
Last updated
07/12/2012
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