1467458927 NPI number — DAVID R FAKIER MD

Table of content: DAVID R FAKIER MD (NPI 1467458927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467458927 NPI number — DAVID R FAKIER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAKIER
Provider First Name:
DAVID
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467458927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
906 PICHELOUP PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70119-3822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-804-3112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
906 PICHELOUP PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70119-3822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-804-3112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  018933 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1071748 . This is a "WV WORKERS COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1467458927 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 211195701 . This is a "TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3810010518 . This is a "MEDICAID WV" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000548194 . This is a "ANTHEM-KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1563209 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101918790 . This is a "MEDICAL ASSISTANCE PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1019187900001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1909173 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 219107 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 91729 . This is a "SIHO-KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 02880871 . This is a "NY MEDICAL ASSISTANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2750303 . This is a "OH MEDICAL ASSISTANCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 101918790 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00405860 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1564931 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50017540 . This is a "PASSPORT-KCR" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2750303 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3425392000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 705750 . This is a "BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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