Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 01078904A | IN |
NPI | 1043282403 |
---|---|
Provider Name | Dr. James William Faulkner III |
First Address | Greenwood, IN 46143-1049 |
Second Address | Greenwood, IN 46143-1049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 20/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00000010099158 | BC/BS PROVIDER # INDIANA (01) | IN |
1615843 | BC/BS PROVIDER # (01) | |
300005511 | (05) | IN |
C48337 | (02) |