Provider Demographics
NPI:1699924209
Name:EMILE FARES M.D. PA
Entity type:Organization
Organization Name:EMILE FARES M.D. PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-644-4442
Mailing Address - Street 1:7338 MCHENRY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-3633
Mailing Address - Country:US
Mailing Address - Phone:713-644-4442
Mailing Address - Fax:713-644-8964
Practice Address - Street 1:1398 ELDRIDGE PKWY
Practice Address - Street 2:SUITE 113
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1692
Practice Address - Country:US
Practice Address - Phone:281-679-9500
Practice Address - Fax:281-679-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2254207Q00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX333487201Medicaid
TX333487202OtherTEXAS HEALTH STEPS
TX333487202OtherTEXAS HEALTH STEPS