Healthcare Provider Details

I. General information

NPI: 1467080713
Provider Name (Legal Business Name): ANAS FARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DAVIS BLVD STE 308
TAMPA FL
33606-3438
US

IV. Provider business mailing address

17 DAVIS BLVD STE 308
TAMPA FL
33606-3438
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-2201
  • Fax:
Mailing address:
  • Phone: 813-974-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.147902
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME174477
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME174477
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number15101
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME174477
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: