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General NPI Number Information
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NPI Number | 1588762132
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Entity Type | Organization
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Legal Business Name | JACK FAUP MD PA
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 1515 PARK CENTER DR SUITE 2-I
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City | ORLANDO
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State | FL
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Zip | 32835-5794
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Country | US
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Telephone | 407-299-3160
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Fax | 407-299-2445
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Provider Business Mailing Address
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Address Line | 1515 PARK CENTER DR SUITE 2-I
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City | ORLANDO
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State | FL
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Zip | 32835-5794
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Country | US
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Telephone | 407-299-3160
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Fax | 407-299-2445
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | JACK FAUP
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Credential | M.D.
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Telephone | 407-299-3160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME15851
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License Number State | FL
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