Individual
PAUL M FANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1720 S BECKHAM AVE STE 104, TYLER, TX 75701-4464
(903) 597-2002
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6450
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
J6425
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123074
SUPERIOR HEALTH CHIPS
TX
05
—
129809302
—
TX
05
—
129809306
—
TX
05
—
1972577419
—
TX
01
—
45-2578435-002
TRICARE
TX
01
—
5623482
AETNA
TX
01
—
75-2616977-136
TRICARE
TX
01
—
752616977022
HUMAN SOUTH MILITARY TRICARE
TX
01
—
83Y684
BCBS OF TEXAS
TX
01
—
8FM313
BCBS
TX
01
—
P01572864
RAIL ROAD MEDICARE
TX
Enumeration date
02/13/2006
Last updated
07/21/2022
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