Healthcare Provider Details

I. General information

NPI: 1376523902
Provider Name (Legal Business Name): JOSEPH B FARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18404 N TATUM BLVD SUITE 101
PHOENIX AZ
85032-1511
US

IV. Provider business mailing address

2500 W UTOPIA RD STE. 100
PHOENIX AZ
85027-4171
US

V. Phone/Fax

Practice location:
  • Phone: 623-580-5390
  • Fax: 623-580-5397
Mailing address:
  • Phone: 602-214-6148
  • Fax: 602-214-6149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA06825900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: