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General NPI Number Information
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NPI Number | 1154377851
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Entity Type | Individual
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Provider Name | JARRAD W FAULK PT
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 3001 ARMAND ST STE F
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City | MONROE
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State | LA
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Zip | 71201-3761
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Country | US
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Telephone | 318-340-6300
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Fax | 318-340-6323
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Provider Business Mailing Address
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Address Line | 2804 CUBA BLVD
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City | MONROE
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State | LA
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Zip | 71201-2014
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Country | US
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Telephone | 318-343-3149
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Fax | 318-325-2022
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 06930
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License Number State | LA
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