Basic Information
| Provider Information | |||||||||
| NPI: | 1508947730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAUGHT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | EARL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 MEDICAL CENTER DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5419308907 | ||||||||
| FaxNumber: | 5412454820 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 MEDICAL CENTER DR | ||||||||
| Address2: | STE 300 | ||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975044316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412826559 | ||||||||
| FaxNumber: | 5412826710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 02/23/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | MD18795 | OR | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | MD18795 | OR | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 02WCGFLE | 01 | OR | MEDICARE | OTHER | 064456 | 05 | OR | MEDICAID | 4898001 | 01 | OR | BLUE CROSS | OTHER |