Provider Demographics
NPI:1225099799
Name:FARO, DAVID JEFFREY (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEFFREY
Last Name:FARO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1023
Mailing Address - Country:US
Mailing Address - Phone:740-446-1860
Mailing Address - Fax:740-446-2994
Practice Address - Street 1:161 3RD AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1023
Practice Address - Country:US
Practice Address - Phone:740-446-1860
Practice Address - Fax:740-446-2994
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002518213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0713651Medicaid
OH0783770001Medicare NSC
OH0713651Medicaid
OH9256121Medicare PIN
OH9256121Medicare ID - Type Unspecified