Provider Demographics
NPI:1013960848
Name:FAREED, DONALD OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:OMAR
Last Name:FAREED
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:PO BOX 50547
Mailing Address - Street 2:1483 EAST VALLEY ROAD STE. 19
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93150-0547
Mailing Address - Country:US
Mailing Address - Phone:805-969-0988
Mailing Address - Fax:805-969-6070
Practice Address - Street 1:1483 E VALLEY RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-1249
Practice Address - Country:US
Practice Address - Phone:805-969-0988
Practice Address - Fax:805-969-6070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23806207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23697Medicare UPIN