Individual
JAY FAWVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 E MAUMEE ST, ANGOLA, IN 46703-2012
(260) 667-5635
(260) 665-8852
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
(260) 266-6013
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01032403A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000490037
ANTHEM BLUE CROSS
IN
Enumeration date
07/12/2006
Last updated
11/08/2023
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