Individual
CRYSTAL D FAUDERE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
700 W CENTRAL AVE, SUITE 205, EL DORADO, KS 67042-2184
(316) 321-2010
(316) 321-8871
Mailing address
700 W CENTRAL AVE, SUITE 205, EL DORADO, KS 67042-2184
(316) 321-2010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
530512
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200331140A
—
KS
Enumeration date
01/27/2006
Last updated
04/08/2010
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