Individual
JOHN MCLAIN FAGGARD III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1005 HIGHWAY 2, SANDPOINT, ID 83864-1702
(208) 265-5916
(208) 255-2066
Mailing address
1005 HIGHWAY 2, SANDPOINT, ID 83864-1702
(208) 265-5916
(208) 255-2066
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M6916
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1138309
PREVIOUS PROVIDER NUMBER
—
Enumeration date
05/09/2007
Last updated
05/14/2012
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