Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0427023 | KS |
Y | 207PE0004X | Emergency Medical Services | 04-27023 | KS |
NPI | 1205942463 |
---|---|
Provider Name | Dr. Gregory G Faimon |
First Address | Valley Center, KS 67147-8716 |
Second Address | Wichita, KS 67220-2729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 22/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100294640H | (05) | KS |
100294640L | (05) | KS |
100294640M | (05) | KS |
100294640W | (05) | KS |
105234 | BC/BS OF KANSAS (01) | KS |
200362720C | (05) | KS |
G63689 | (02) | KS |
P00615213 | RR MC (PALMETTO) (01) | KS |