MEDICARE: JACK FAUP MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME15851	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588762132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACK FAUP MD PA

Provider Business Mailing Address
First Line	:	1515 PARK CENTER DR
Second Line	:	SUITE 2-I
City	:	ORLANDO
State	:	FL
Zip	:	32835-5794
Country	:	US
Telephone Number	:	407-299-3160
Fax Number	:	407-299-2445

Provider Business Practice Location Address
First Line	:	1515 PARK CENTER DR
Second Line	:	SUITE 2-I
City	:	ORLANDO
State	:	FL
Zip	:	32835-5794
Country	:	US
Telephone Number	:	407-299-3160
Fax Number	:	407-299-2445

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	JACK FAUP
Credential	:	M.D.
Telephone Number	:	407-299-3160

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/14/2008

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