Provider Demographics
NPI:1700855269
Name:FAUCONIER, IAN NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:NORMAN
Last Name:FAUCONIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 WILSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7885
Mailing Address - Country:US
Mailing Address - Phone:831-649-1000
Mailing Address - Fax:
Practice Address - Street 1:559 ABBOTT ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4325
Practice Address - Country:US
Practice Address - Phone:831-422-4500
Practice Address - Fax:831-422-5195
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41873208800000X
CAG87817208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57771766Medicaid
COH05430Medicare UPIN
COC530858Medicare PIN