Provider Demographics
NPI:1346200623
Name:FAUSETT, JAMES ALBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALBERT
Last Name:FAUSETT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 S. PECOS MCLEOD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-4265
Mailing Address - Country:US
Mailing Address - Phone:702-434-2023
Mailing Address - Fax:702-434-1976
Practice Address - Street 1:3777 S. PECOS MCLEOD
Practice Address - Street 2:SUITE 103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4265
Practice Address - Country:US
Practice Address - Phone:702-434-2023
Practice Address - Fax:702-434-1976
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9702213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002102001Medicaid
NV480025767OtherRAILROAD MEDICARE ID #
NV002102001Medicaid
NVT11088Medicare UPIN