Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 306787 | LA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 603787 | LA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | P8665 | TX |
NPI | 1063684314 |
---|---|
Provider Name | John Robert Faust |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Baton Rouge, LA 70809-3481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2008 |
Last Update Date | 24/12/2020 |