Individual
DR. LARRY RALPH FANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
612 E UNIVERSITY AVE, GEORGETOWN, TX 78626-7034
(512) 930-5437
Mailing address
205 E UNIVERSITY AVE, SUITE 200, GEORGETOWN, TX 78626-6814
(512) 686-0207
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
D7566
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1309775-01
—
TX
Enumeration date
05/10/2006
Last updated
03/09/2011
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