=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437382520
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH F. FAUST, M.D., P.L.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2009
-----------------------------------------------------
Last Update Date | 08/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 804 MARGARET ST
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32204-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-359-2020
-----------------------------------------------------
Fax | 904-353-9040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 804 MARGARET ST
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32204-3224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-359-2020
-----------------------------------------------------
Fax | 904-353-9040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PRESIDENT
-----------------------------------------------------
Name | DR. JOSEPH F FAUST
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 904-359-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------