Provider Demographics
NPI:1740393131
Name:FARIAS, ROBERT (CFA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:FARIAS
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9539 MAJESTIC RD
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-7741
Mailing Address - Country:US
Mailing Address - Phone:303-652-6040
Mailing Address - Fax:303-652-6090
Practice Address - Street 1:9539 MAJESTIC RD
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-7741
Practice Address - Country:US
Practice Address - Phone:303-652-6040
Practice Address - Fax:303-652-6090
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00F638363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical