Provider Demographics
NPI:1518295013
Name:ROBERT J FAUER M.D. P.C
Entity Type:Organization
Organization Name:ROBERT J FAUER M.D. P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-923-6666
Mailing Address - Street 1:4045 E BELL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2236
Mailing Address - Country:US
Mailing Address - Phone:602-923-6666
Mailing Address - Fax:602-923-7676
Practice Address - Street 1:4045 E BELL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2236
Practice Address - Country:US
Practice Address - Phone:602-923-6666
Practice Address - Fax:602-923-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ14204261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZMD14204OtherMEDICARE PROVIDER
AZAZ0184030OtherBLUE CROSS BLUE SHIELD OF AZ
AZAZ0184030OtherBLUE CROSS BLUE SHIELD OF AZ