Provider Demographics
NPI:1588622617
Name:FACUNDUS, EDWARD CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:CRAIG
Last Name:FACUNDUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CHATEAU DR SW
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6436
Mailing Address - Country:US
Mailing Address - Phone:256-880-1977
Mailing Address - Fax:256-880-6022
Practice Address - Street 1:250 CHATEAU DR SW
Practice Address - Street 2:SUITE 105
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6436
Practice Address - Country:US
Practice Address - Phone:256-880-1977
Practice Address - Fax:256-880-6022
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19052174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG10030Medicare UPIN