Provider Demographics
NPI:1376523902
Name:FARES, JOSEPH B (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:FARES
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 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1511
Practice Address - Country:US
Practice Address - Phone:623-580-5390
Practice Address - Fax:623-580-5397
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06825900207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z3840OtherHEALTHNET
AZ100919Medicaid
AZZP00349542OtherMEDICARE RAILROAD
AZ7272302OtherAETNA
AZAZ042595910OtherBLUE CROSS BLUE SHIELD
AZ7272302OtherAETNA
AZP00349542Medicare ID - Type UnspecifiedRAILROAD MEDICARE
AZZP00349542OtherMEDICARE RAILROAD