Active NPI
Steven Earl Fandre, PA
- Medical Physician Assistant
- Richardson, TX
National Provider Identifier
1891847182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA00241
- Practice address
- 630 N Coit Rd
Suite 2200
Richardson, TX 75080-3700 - Phone
- (214) 389-7431
- NPI assigned
- Jan 17, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA00241 | TX | Primary |
Addresses
Primary practice location
630 N Coit Rd
Suite 2200
Richardson, TX 75080-3700
Mailing address
1322 Lakeridge LN
Irving, TX 75063-5079
Phone (214) 850-5377
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00241 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891847182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1322 LAKERIDGE LN",
"city": "IRVING",
"state": "TX",
"postal_code": "750635079",
"telephone_number": "214-850-5377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "630 N COIT RD",
"address_2": "SUITE 2200",
"city": "RICHARDSON",
"state": "TX",
"postal_code": "750803700",
"telephone_number": "214-389-7431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FANDRE",
"first_name": "STEVEN",
"middle_name": "EARL",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA00241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richardson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.