Provider Demographics
NPI:1699723908
Name:FARO, EDMUND (MD)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:FARO
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 1:6301 MOUNTAIN VISTA ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2364
Mailing Address - Country:US
Mailing Address - Phone:702-614-5437
Mailing Address - Fax:702-990-9922
Practice Address - Street 1:6301 MOUNTAIN VISTA ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2364
Practice Address - Country:US
Practice Address - Phone:702-614-5437
Practice Address - Fax:702-990-9922
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV9068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H84758Medicare UPIN
37297Medicare ID - Type Unspecified