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General NPI Number Information
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NPI Number | 1376523902
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Entity Type | Individual
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Provider Name | JOSEPH B FARES MD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 09/25/2013
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Provider Practice Location Address
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Address Line | 18404 N TATUM BLVD SUITE 101
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City | PHOENIX
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State | AZ
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Zip | 85032-1511
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Country | US
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Telephone | 623-580-5390
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Fax | 623-580-5397
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Provider Business Mailing Address
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Address Line | 2500 W UTOPIA RD STE. 100
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City | PHOENIX
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State | AZ
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Zip | 85027-4171
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Country | US
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Telephone | 602-214-6148
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Fax | 602-214-6149
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 25MA06825900
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License Number State | NJ
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