Provider Demographics
NPI:1275755217
Name:ROBERTO FARS, MD PC
Entity Type:Organization
Organization Name:ROBERTO FARS, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:FARS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-673-5501
Mailing Address - Street 1:813 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-2729
Mailing Address - Country:US
Mailing Address - Phone:307-673-5501
Mailing Address - Fax:307-673-5434
Practice Address - Street 1:813 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2729
Practice Address - Country:US
Practice Address - Phone:307-673-5501
Practice Address - Fax:307-673-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6773A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY311706OtherBLUE CROSS
WY311706OtherBLUE CROSS