Individual
DR. EDWARD FASOLINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1001 ARBOR PARK, BELTON, TX 76513-8196
(254) 831-2000
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H8637
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87G900
BLUE SHIELD
TX
Enumeration date
03/25/2006
Last updated
04/10/2020
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