Provider Demographics
NPI:1265599823
Name:FAUROT, JAY L III (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:L
Last Name:FAUROT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7536
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205
Mailing Address - Country:US
Mailing Address - Phone:573-445-7300
Mailing Address - Fax:573-445-7301
Practice Address - Street 1:404 KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:572-445-7300
Practice Address - Fax:573-445-7301
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO103138207L00000X
MO26300207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO050042925OtherRR MEDICARE
MO20610907Medicaid
MO044060150Medicare ID - Type Unspecified
MO20610907Medicaid
MOF68250Medicare UPIN