Provider Demographics
NPI:1275510943
Name:FAUST, JAMES RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:FAUST
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 1:1215 PLEASANT ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1418
Mailing Address - Country:US
Mailing Address - Phone:515-241-5722
Mailing Address - Fax:
Practice Address - Street 1:1215 PLEASANT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1416
Practice Address - Country:US
Practice Address - Phone:515-241-5722
Practice Address - Fax:515-241-4403
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA25103207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0048264Medicaid
IA4284OtherMIDLANDS PROVIDER #
IA28055OtherBLUE SHIELD PROVIDER #
IA25103OtherTRICARE PROVIDER #
IAIA0120OtherJOHN DEERE PROVIDER #
IAIA0120OtherJOHN DEERE PROVIDER #
IA0048264Medicaid