Provider Demographics
NPI:1306985866
Name:FAIRWEATHER, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:FAIRWEATHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13920 OSPREY CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1615
Mailing Address - Country:US
Mailing Address - Phone:832-831-9877
Mailing Address - Fax:832-240-4098
Practice Address - Street 1:13920 OSPREY CT
Practice Address - Street 2:SUITE C
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1615
Practice Address - Country:US
Practice Address - Phone:832-831-9877
Practice Address - Fax:832-240-4098
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7373208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1650564401Medicaid
TX8B1244Medicare PIN
H92192Medicare UPIN