Healthcare Provider Details

I. General information

NPI: 1295730836
Provider Name (Legal Business Name): JAMES VANNOY FARIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

IV. Provider business mailing address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

V. Phone/Fax

Practice location:
  • Phone: 812-331-3402
  • Fax: 812-355-6549
Mailing address:
  • Phone: 812-331-3402
  • Fax: 812-355-6549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01022156A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01022156A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: