Individual
JAY PHILIP FAKIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(985) 859-9669
Mailing address
436 RAILSBACK ST, SHREVEPORT, LA 71106-7726
(985) 859-9669
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
201278
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1054925
—
LA
Enumeration date
04/03/2007
Last updated
03/01/2024
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