Provider Demographics
NPI:1023153335
Name:FAULKNER, MARVIN LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:LYNN
Last Name:FAULKNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:MR
Other - First Name:MARVIN
Other - Middle Name:LYNN
Other - Last Name:FAULKNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:11227 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66219-1399
Mailing Address - Country:US
Mailing Address - Phone:913-730-1100
Mailing Address - Fax:913-730-1101
Practice Address - Street 1:11227 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1399
Practice Address - Country:US
Practice Address - Phone:913-730-1100
Practice Address - Fax:913-730-1101
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4423207LP2900X, 207L00000X
KS0523470207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology