Healthcare Provider Details

I. General information

NPI: 1205942463
Provider Name (Legal Business Name): GREGORY G FAIMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 N WOODLAWN ST
WICHITA KS
67220-2729
US

IV. Provider business mailing address

3800 E 93RD ST N
VALLEY CENTER KS
67147-8716
US

V. Phone/Fax

Practice location:
  • Phone: 316-858-2610
  • Fax: 316-858-2793
Mailing address:
  • Phone: 316-650-2878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0427023
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number04-27023
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: