Healthcare Provider Details

I. General information

NPI: 1457319360
Provider Name (Legal Business Name): ANN ELIZABETH FARASH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST ROOM 1A132
BILOXI MS
39534-2508
US

IV. Provider business mailing address

3031 WIND WOOD DR
OCEAN SPRINGS MS
39564-5963
US

V. Phone/Fax

Practice location:
  • Phone: 228-377-8185
  • Fax:
Mailing address:
  • Phone: 228-818-5918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL#018553
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: