Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 8739 | AL |
NPI | 1013071984 |
---|---|
Provider Name | Dr. Scott Lee Faulkner |
First Address | Montgomery, AL 36124-2848 |
Second Address | Nashville, TN 37203-2010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 10/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C76360 | (02) | AL |