Provider Demographics
NPI:1376575043
Name:FARIS, BISHARA M (MD)
Entity Type:Individual
Prefix:
First Name:BISHARA
Middle Name:M
Last Name:FARIS
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 1:806 E WINDWARD WAY
Mailing Address - Street 2:UNIT 114, BLDG. 3
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-8011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-422-8729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027354207W00000X
WV10942207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmology