John M. Fackler M.D. PA

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

K2687 Issued in TX

Legal business name

JOHN M. FACKLER M.D. PA

Practice address

1501 River Pointe Dr
Suite 100
Conroe, TX 77304-2656

Phone

(936) 539-2663

Fax

(936) 539-2664

NPI assigned

Aug 26, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John M Fackler, M.D. PA

Title

President/Owner

Phone

(936) 539-2663

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391731200000",
    "number": "1184904765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 RIVER POINTE DR",
            "address_2": "SUITE 100",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042656",
            "telephone_number": "936-539-2663",
            "fax_number": "936-539-2664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 RIVER POINTE DR",
            "address_2": "SUITE 100",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773042656",
            "telephone_number": "936-539-2663",
            "fax_number": "936-539-2664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN M. FACKLER M.D. PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-26",
        "last_updated": "2014-02-07",
        "status": "A",
        "authorized_official_last_name": "FACKLER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "936-539-2663",
        "authorized_official_credential": "M.D. PA"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "TX",
            "license": "K2687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "031123501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.