Provider Demographics
NPI:1326174954
Name:FAUST, MARK ROBERT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ROBERT
Last Name:FAUST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:22813 N 105TH DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-5707
Mailing Address - Country:US
Mailing Address - Phone:623-492-0214
Mailing Address - Fax:
Practice Address - Street 1:8631 W UNION HILLS DR
Practice Address - Street 2:SUITE #206
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-7002
Practice Address - Country:US
Practice Address - Phone:623-875-7900
Practice Address - Fax:623-875-7919
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3571363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical