Basic Information
| Provider Information | |||||||||
| NPI: | 1700103132 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FABELA | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4561 HERITAGE TRACE PKWY STE 109 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762448907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6822000035 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3455 LOCKE AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761075745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173361189 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2010 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | P5178 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3226417-01 | 05 | TX | MEDICAID | 299305YNGS | 01 | TX | MEDICARE - MCNT - TARRANT | OTHER | 322641702 | 01 | TX | MEDICAID - MCNT - TARRANT | OTHER |