Provider Demographics
NPI:1871592006
Name:FASELER, ROBERT YATES (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:YATES
Last Name:FASELER
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 1:882 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-5607
Mailing Address - Country:US
Mailing Address - Phone:409-722-1234
Mailing Address - Fax:409-722-3270
Practice Address - Street 1:882 SIERRA DR
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-5607
Practice Address - Country:US
Practice Address - Phone:409-722-1234
Practice Address - Fax:409-722-3270
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131989905Medicaid
TX00QD35Medicare ID - Type Unspecified
TXA66328Medicare UPIN