Provider Demographics
NPI:1891025615
Name:FARIS AL-GEBORY MD LLC
Entity Type:Organization
Organization Name:FARIS AL-GEBORY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-GEBORY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-717-1700
Mailing Address - Street 1:11517 TIVOLI LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3539
Mailing Address - Country:US
Mailing Address - Phone:636-717-1700
Mailing Address - Fax:
Practice Address - Street 1:1011 BOWLES AVE
Practice Address - Street 2:SUITE 415
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-2395
Practice Address - Country:US
Practice Address - Phone:636-717-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008032789208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty