Provider Demographics
NPI:1477533578
Name:FARIS, WAGDI (MD)
Entity Type:Individual
Prefix:DR
First Name:WAGDI
Middle Name:
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 1:2727 SE MARICAMP RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-629-9566
Mailing Address - Fax:352-629-0155
Practice Address - Street 1:2727 SE MARICAMP RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471
Practice Address - Country:US
Practice Address - Phone:352-629-9566
Practice Address - Fax:352-629-0155
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027677207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0612640001OtherCIGNA PAL
1038979OtherAETNA HMO
0612640OtherCIGNA
42113OtherBCBS
5967300OtherAETNA NON HMO
0900ZOtherVANTAGE
204580OtherAVMED
D54775Medicare UPIN
5967300OtherAETNA NON HMO