Healthcare Provider Details

I. General information

NPI: 1346200623
Provider Name (Legal Business Name): JAMES ALBERT FAUSETT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3777 S. PECOS MCLEOD SUITE 103
LAS VEGAS NV
89121-4265
US

IV. Provider business mailing address

3777 S. PECOS MCLEOD SUITE 103
LAS VEGAS NV
89121-4265
US

V. Phone/Fax

Practice location:
  • Phone: 702-434-2023
  • Fax: 702-434-1976
Mailing address:
  • Phone: 702-434-2023
  • Fax: 702-434-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number9702
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: