Healthcare Provider Details

I. General information

NPI: 1518911874
Provider Name (Legal Business Name): JAMES W FAULK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 SHERMAN ST
JAMESTOWN NY
14701-7079
US

IV. Provider business mailing address

PO BOX 41
JAMESTOWN NY
14702-0041
US

V. Phone/Fax

Practice location:
  • Phone: 716-483-3619
  • Fax: 716-484-9633
Mailing address:
  • Phone: 716-487-1124
  • Fax: 716-487-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number097239
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: