Provider Demographics
NPI:1215614813
Name:FELLIN, ERIC (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:FELLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARL R DARNALL ARMY MEDICAL CENTER EMERGENCY DEPARTMENT
Mailing Address - Street 2:590 MEDICAL CENTER ROAD
Mailing Address - City:FORT CAVAZOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARL R DARNALL ARMY MEDICAL CENTER EMERGENCY DEPARTMENT
Practice Address - Street 2:509 MEDICAL CENTER ROAD
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:76554
Practice Address - Country:US
Practice Address - Phone:254-553-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program