Provider Demographics
NPI:1275732158
Name:FAULCON, CLARENCE L (MD)
Entity Type:Individual
Prefix:
First Name:CLARENCE
Middle Name:L
Last Name:FAULCON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:NEWTON GROVE
Mailing Address - State:NC
Mailing Address - Zip Code:28366-0227
Mailing Address - Country:US
Mailing Address - Phone:910-567-6194
Mailing Address - Fax:910-567-5342
Practice Address - Street 1:500 S FAYETTEVILLE ST
Practice Address - Street 2:
Practice Address - City:SALEMBURG
Practice Address - State:NC
Practice Address - Zip Code:28385-8406
Practice Address - Country:US
Practice Address - Phone:910-525-5515
Practice Address - Fax:910-525-5545
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC30334207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine