Healthcare Provider Details

I. General information

NPI: 1346043536
Provider Name (Legal Business Name): AUSTIN BLAKE FAERBER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-7001
US

IV. Provider business mailing address

1764 WOODS BEND LN
WILDWOOD MO
63038-1448
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-5116
  • Fax:
Mailing address:
  • Phone: 314-541-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: