Provider Demographics
NPI:1720074313
Name:FAREED, GEORGE CARR (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CARR
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 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:751 W LEGION RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7754
Practice Address - Country:US
Practice Address - Phone:760-344-8750
Practice Address - Fax:760-344-0558
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31850174400000X, 207Q00000X, 208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG31850Medicare PIN
CAF02073Medicare UPIN
CAF02073Medicare UPIN