Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | ME139617 | FL |
NPI | 1013363464 |
---|---|
Provider Name | Dr. Colton Austin Faza |
First Address | Greenville, NC 27834-2818 |
Second Address | Greenville, NC 27834-2818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2016 |
Last Update Date | 20/01/2021 |