Physician Compare National (NPI:1427122118)

HEALTHCARE PROVIDER:

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

Individual Professional Information
NPI	1427122118
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2668576570
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110914000813
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	FARES
	Individual professional last name
Provider First Name	JOSEPH
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1973
	Individual professional's medical school graduation year
Primary Specialty	OTOLARYNGOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PLASTIC AND RECONSTRUCTIVE SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PLASTIC AND RECONSTRUCTIVE SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	4306 UNIVERSITY BLVD S
	Group Practice or individual's line 1 address
City	JACKSONVILLE
	Group Practice or individual's city
State	FL
	Group Practice or individual's state
Zip Code	322164910
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y