Individual
MR. RICKEY SAM FAUVOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2512 N STOKESBERRY PL STE 102, MERIDIAN, ID 83646-1135
(208) 229-3238
(208) 880-4245
Mailing address
1939 E BURNSIDE ST, PORTLAND, OR 97214-1535
(503) 233-6141
(503) 233-2889
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
HA3089
ID
237700000X
Hearing Instrument Specialist
HAS-P-916188
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82-3793314
INSURANCE
ID
05
—
82-3793314
—
ID
Enumeration date
12/13/2006
Last updated
01/18/2021
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