Provider Demographics
NPI:1477663870
Name:FARYAN, MARK WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:FARYAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:20118 NEILSON RD
Mailing Address - Street 2:
Mailing Address - City:PINE GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95665-9681
Mailing Address - Country:US
Mailing Address - Phone:209-267-1011
Mailing Address - Fax:209-267-1030
Practice Address - Street 1:431 SUTTER HILL RD
Practice Address - Street 2:
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-4147
Practice Address - Country:US
Practice Address - Phone:209-267-1011
Practice Address - Fax:209-267-1030
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5644207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE64332Medicare UPIN