Individual
MITCHELL FRANKLIN FAGELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
M4058
TX
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
M4058
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2012460
—
TX
01
—
6484850003
MEDICARE NSC - EFFECT. 02/01/11
TX
01
—
8CR160
BCBS TX 02/01/2011
TX
01
—
P00913362
MEDICARE RAILROAD - EFFECT. 02/01/11
TX
01
—
TXB117511
MEDICARE PART B - EFFECT. 02/01/2011
TX
Enumeration date
10/12/2006
Last updated
02/01/2017
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