MEDICARE: MR. DAVID ALLEN FAULKNER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1619292653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ALLEN FAULKNER

Provider Business Mailing Address
First Line	:	3025 N WYATT DR
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4189
Country	:	US
Telephone Number	:	870-862-8057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3025 N WYATT DR
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-4189
Country	:	US
Telephone Number	:	870-862-8057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	04/01/2010

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Directions to “ MR. DAVID ALLEN FAULKNER ” Practice Location

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