Provider Demographics
NPI:1104826965
Name:FAULKNER, C BYRON (MD)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:BYRON
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 E KINGSLEY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7216
Mailing Address - Country:US
Mailing Address - Phone:417-887-1965
Mailing Address - Fax:417-887-6499
Practice Address - Street 1:1330 E KINGSLEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7216
Practice Address - Country:US
Practice Address - Phone:417-887-1965
Practice Address - Fax:417-887-6499
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO104165207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206699209Medicaid
000002588Medicare ID - Type Unspecified
MO206699209Medicaid
MO0659840001Medicare NSC