Individual
DR. JAY L FAUROT III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
404 KEENE ST, COLUMBIA, MO 65201
(572) 445-7300
(573) 445-7301
Mailing address
PO BOX 7536, COLUMBIA, MO 65205
(573) 445-7300
(573) 445-7301
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
103138
MO
207L00000X
Anesthesiology Physician
26300
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050042925
RR MEDICARE
MO
05
—
20610907
—
MO
Enumeration date
01/03/2007
Last updated
11/19/2010
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