Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 5270 | DC |
N | 2080A0000X | Adolescent Medicine | 5270 | DC |
NPI | 1316126626 |
---|---|
Provider Name | Dr. Walter Lee Faggett Ii |
First Address | Washington, DC 20011-7001 |
Second Address | Washington, DC 20011-7001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2007 |
Last Update Date | 18/03/2010 |