Physician Compare National (NPI:1114901113)

HEALTHCARE PROVIDER: RUSSELL WILLIAM FARIA D.O.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1114901113
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0042301798
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20070809000289
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FARIA
	Individual professional last name
Provider First Name	RUSSELL
	Individual professional first name
Provider Middle Name	W
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	COLLEGE OF OSTEOPATHIC PHYSICIANS AND SURGEONS OF LOS ANGELES
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	FAMILY MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	ANESTHESIOLOGY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	ANESTHESIOLOGY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	721 M ST NE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 100
	Group Practice or individual's line 2 address
City	AUBURN
	Group Practice or individual's city
State	WA
	Group Practice or individual's state
Zip Code	980024503
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y