Basic Information
Provider Information | |||||||||
NPI: | 1295782738 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FAYLE | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | W. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6400 FANNIN ST STE 2800 | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770301534 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7137047100 | ||||||||
FaxNumber: | 7137041796 | ||||||||
Practice Location | |||||||||
Address1: | 4141 VISTA RD | ||||||||
Address2: |   | ||||||||
City: | PASADENA | ||||||||
State: | TX | ||||||||
PostalCode: | 775042113 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7139473100 | ||||||||
FaxNumber: | 7139476103 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/30/2006 | ||||||||
LastUpdateDate: | 07/17/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | E6345 | TX | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084S0012X | E6345 | TX | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
ID | Type | State | Issuer | Description | 153449704 | 01 | TX | MISCHER MDCD GRP TPI HARRIS CO | OTHER | 00106W | 01 | TX | MISCHER MDCR GRP PTAN HARRIS CO | OTHER | 0035TD | 01 | TX | MISCHER BCBSTX GRP PROV REC | OTHER | 00X185 | 01 | TX | MISCHER MDCR PTAN BRAZORIA CO | OTHER | 302679101 | 01 | TX | MISCHER MDCD GRP TPI BRAZORIA CO | OTHER |