Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 13540 | MO |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 6713 | KS |
NPI | 1013996115 |
---|---|
Provider Name | Douglas W Fain |
First Address | Olathe, KS 66062-9131 |
Second Address | Olathe, KS 66062-9131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 25/03/2017 |