Provider Demographics
NPI:1154398477
Name:FAULK, RICHARD SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:FAULK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 W CAMINO REAL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5578
Mailing Address - Country:US
Mailing Address - Phone:561-218-1798
Mailing Address - Fax:561-391-5054
Practice Address - Street 1:7100 W CAMINO REAL
Practice Address - Street 2:SUITE 202
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5578
Practice Address - Country:US
Practice Address - Phone:561-218-1798
Practice Address - Fax:561-391-5054
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2021-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-00719872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG04956Medicare UPIN
FL42837Medicare ID - Type UnspecifiedPROVIDER NUMBER