Provider Demographics
NPI:1598767634
Name:FARIS, TALAL (MD)
Entity Type:Individual
Prefix:DR
First Name:TALAL
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 1:7414 COMMUNITY CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7101
Mailing Address - Country:US
Mailing Address - Phone:727-868-3200
Mailing Address - Fax:727-868-3204
Practice Address - Street 1:7414 COMMUNITY CT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7101
Practice Address - Country:US
Practice Address - Phone:727-868-3200
Practice Address - Fax:727-868-3204
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0078645207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49562OtherBCBS
FL257413600Medicaid
FLE2771WMedicare PIN