Fawks, Ian Lester

Fawks, Ian Lester is an individual health care provider with primary practice located at 3801 S National Ave , Springfield MO 65807-5210. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Fawks, Ian Lester can be contacted via phone (417) 269-7728.

Contact Information

Primary practice address
3801 S National Ave Springfield MO 65807-5210
Phone: (417) 269-7728
Fax: (417) 269-7729
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 115964 Missouri

Profile Details

NPI number 1386640910
LBN Legal business name Fawks, Ian Lester
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 28th, 2005
Last updated Dec 2nd, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386640910 NPPES
Other 129355 BLUE CROSS
MEDICAID 244976403 BLUE CROSS

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