Provider Demographics
NPI:1326047721
Name:FAUR, LYNN VAN VALER (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:VAN VALER
Last Name:FAUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3717 MAPLECREST RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-8424
Mailing Address - Country:US
Mailing Address - Phone:260-486-7334
Mailing Address - Fax:260-486-6447
Practice Address - Street 1:3717 MAPLECREST RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-8424
Practice Address - Country:US
Practice Address - Phone:260-486-7334
Practice Address - Fax:260-486-6447
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050882207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200284730Medicaid
IN668020A8Medicare PIN
370800HMedicare PIN
IN668030A8Medicare PIN
IN090430A2Medicare PIN
H15160Medicare UPIN
IN668040A8Medicare PIN
IN192240EEEEMedicare PIN
INP00413736Medicare PIN