Provider Demographics
NPI:1275534414
Name:FAUREST, JOHN O (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:O
Last Name:FAUREST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-447-3242
Mailing Address - Fax:502-448-4722
Practice Address - Street 1:5129 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1727
Practice Address - Country:US
Practice Address - Phone:502-447-3242
Practice Address - Fax:502-448-4722
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY16056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00546118Medicare Oscar/Certification
KYC73112Medicare UPIN
KYP00298435Medicare PIN