Individual
DR. S BLAIR FAULKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
340 S WILLARD ST, COTTONWOOD, AZ 86326-4126
(928) 639-6025
(928) 649-7921
Mailing address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 213-6235
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
38052
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0116839
—
MS
05
—
316409
—
AZ
01
—
P01108741
RAILROAD MEDICARE
AZ
Enumeration date
06/29/2006
Last updated
09/08/2020
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