MEDICARE: JOSEPH B FARES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	25MA06825900	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	ZP00349542	OTHER	AZ	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2Z3840	OTHER	AZ	HEALTHNET
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7272302	OTHER	AZ	AETNA
5	AZ042595910	OTHER	AZ	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1376523902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH B FARES MD

Provider Business Mailing Address
First Line	:	2500 W UTOPIA RD
Second Line	:	STE. 100
City	:	PHOENIX
State	:	AZ
Zip	:	85027-4171
Country	:	US
Telephone Number	:	602-214-6148
Fax Number	:	602-214-6149

Provider Business Practice Location Address
First Line	:	18404 N TATUM BLVD
Second Line	:	SUITE 101
City	:	PHOENIX
State	:	AZ
Zip	:	85032-1511
Country	:	US
Telephone Number	:	623-580-5390
Fax Number	:	623-580-5397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	09/25/2013

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Directions to “ JOSEPH B FARES MD” Practice Location

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