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Individual

BRADLEY DARRELL FAGLIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1001 W EAGLE DR, DECATUR, TX 76234-3745
(940) 627-7443
(940) 627-7597
Mailing address
1001 W EAGLE DR, DECATUR, TX 76234-3745
(940) 627-7443
(940) 627-7464

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
N5045
TX
208000000X
Pediatrics Physician
N5045
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
220200401
TX
01
P00964976
RAILROAD MEDICARE
TX
Enumeration date
10/29/2008
Last updated
09/22/2016
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