Individual
LYNN VAN VALER FAUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3717 MAPLECREST RD, FORT WAYNE, IN 46815-8424
(260) 486-7334
(260) 486-6447
Mailing address
3717 MAPLECREST RD, FORT WAYNE, IN 46815-8424
(260) 486-7334
(260) 486-6447
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01050882
IN
207QA0401X
Addiction Medicine (Family Medicine) Physician
01050882
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200284730
—
IN
Enumeration date
07/18/2005
Last updated
08/20/2013
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