Provider Demographics
NPI:1922179712
Name:FARIS, BUD E (DO)
Entity Type:Individual
Prefix:DR
First Name:BUD
Middle Name:E
Last Name:FARIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S BLISS
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029
Mailing Address - Country:US
Mailing Address - Phone:806-935-4166
Mailing Address - Fax:806-935-3903
Practice Address - Street 1:725 S BLISS
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029
Practice Address - Country:US
Practice Address - Phone:806-935-4166
Practice Address - Fax:806-935-3903
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00JY37Medicare ID - Type Unspecified
A66319Medicare UPIN