Provider Demographics
NPI:1609884006
Name:FAULKNER, DALE A (MD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:A
Last Name:FAULKNER
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 1:201 FM 3237 STE 126
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-2117
Mailing Address - Country:US
Mailing Address - Phone:512-481-2135
Mailing Address - Fax:630-246-2524
Practice Address - Street 1:201 FM 3237 STE 126
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-2117
Practice Address - Country:US
Practice Address - Phone:512-481-2135
Practice Address - Fax:630-246-2524
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8705207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22644Medicare UPIN
TX081A651Medicare ID - Type Unspecified