Provider Demographics
NPI:1235193145
Name:JAARA, FAROUK M (MD)
Entity Type:Individual
Prefix:DR
First Name:FAROUK
Middle Name:M
Last Name:JAARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-0378
Mailing Address - Country:US
Mailing Address - Phone:419-953-1989
Mailing Address - Fax:419-586-4865
Practice Address - Street 1:803 N SALK DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222-5447
Practice Address - Country:US
Practice Address - Phone:520-836-6682
Practice Address - Fax:602-240-6177
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64152207R00000X, 207RC0000X
OH35.046352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ114310Medicaid
AZ114310Medicaid
AZ110427Medicare ID - Type UnspecifiedWCGKH MARICOPA CO
IN264910ATTTMedicare ID - Type Unspecified
AZA80089Medicare UPIN