Provider Demographics
NPI:1578593653
Name:FAULKNER, HENRY WADE (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:WADE
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:250 STATE FARM PKWY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-7181
Mailing Address - Country:US
Mailing Address - Phone:205-943-4650
Mailing Address - Fax:205-943-4688
Practice Address - Street 1:3290 DAUPHIN ST
Practice Address - Street 2:SUITE 401
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-4062
Practice Address - Country:US
Practice Address - Phone:251-471-3309
Practice Address - Fax:251-471-5046
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3688207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1578593653Medicaid
AL515-19305OtherBC-3290 DAUPHIN ST, SUITE 401, MOBILE
AL515-47835OtherBC-6801 AIRPORT BLVD, MOBILE
AL699543OtherFIRST HEALTH
P00085469OtherRR MEDICARE PGBA
AL515-47838OtherBC-750 MORPHY AVE, FAIRHOPE
AL770610758OtherHEALTHCHOICE
AL051519305OtherBCBS
AL510-10235OtherBC-2003 MEDICAL CENTER DR, BAY MINETTE
AL515-47834OtherBC-1815 HAND AVE, BAY MINETTE
AL515-47837OtherBC-3719 DAUPHIN ST, MOBILE
ALC75158OtherHEALTHSPRING
AL051519305Medicaid
AL0810058OtherUNITED HEALTHCARE
AL510-10216OtherBC-7101 US HWY 90, DAPHNE
ALC75158OtherSENIORS FIRST
AL510-10218OtherBC-1811 HAND AVE, BAY MINETTE
AL515-47032OtherBC-6144 A AIRPORT BLVD
AL515-47836OtherBC-5 MOBILE INFIRMARY CIRCLE, MOBILE
ALC75158OtherVIVA
AL1578593653Medicare PIN
AL510-10218OtherBC-1811 HAND AVE, BAY MINETTE
AL515-47838OtherBC-750 MORPHY AVE, FAIRHOPE
AL051519305Medicare PIN