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General NPI Number Information
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NPI Number | 1104024397
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Entity Type | Organization
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Legal Business Name | JOHN M FAGGARD III, MD
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 1005 HIGHWAY 2 W
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City | SANDPOINT
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State | ID
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Zip | 83864-1702
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Country | US
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Telephone | 208-265-5916
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Fax | 208-255-2066
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Provider Business Mailing Address
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Address Line | 1005 HIGHWAY 2 W
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City | SANDPOINT
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State | ID
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Zip | 83864-1702
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Country | US
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Telephone | 208-265-5916
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Fax | 208-255-2066
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Authorized Official
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Title or Position | OWNER
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Name | JOHN M FAGGARD III
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Credential | MD
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Telephone | 208-265-5916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M6916
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License Number State | ID
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