Provider Demographics
NPI:1295923043
Name:FAULSTICK, DYREL ALDEN (MD)
Entity type:Individual
Prefix:DR
First Name:DYREL
Middle Name:ALDEN
Last Name:FAULSTICK
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:HC 60 BOX 76001
Mailing Address - Street 2:
Mailing Address - City:ROUND MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89045-9654
Mailing Address - Country:US
Mailing Address - Phone:775-964-1021
Mailing Address - Fax:
Practice Address - Street 1:HC 60 BOX 76001
Practice Address - Street 2:
Practice Address - City:ROUND MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89045-9654
Practice Address - Country:US
Practice Address - Phone:775-964-1021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5647207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease