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General NPI Number Information
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NPI Number | 1770761355
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Entity Type | Individual
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Provider Name | JAY R. FARIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 55 MAUI LANI PKWY
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City | WAILUKU
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State | HI
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Zip | 96793-2416
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Country | US
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Telephone | 808-243-6050
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Fax |
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Provider Business Mailing Address
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Address Line | 55 MAUI LANI PKWY
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City | WAILUKU
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State | HI
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Zip | 96793-2416
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Country | US
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Telephone | 808-243-6050
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Fax |
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | MD-14450
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD151178
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD14450
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License Number State | HI
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