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Organization
RUSSELL W FARIA DO PC
Active
Organization
RUSSELL W FARIA DO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRISH BUKAUSKAS (BILLING MGR)
(843) 293-9966
Entity
Organization
Contact information
Practice address
15215 SE 272ND ST STE 103, KENT, WA 98042-4215
(253) 639-1883
(253) 639-1891
Mailing address
15215 SE 272ND ST STE 103, KENT, WA 98042-4215
(253) 639-1883
(253) 639-1891
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D020354
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150278
—
OR
01
—
D020354
LICENSE NUMBER
OR
Enumeration date
03/04/2008
Last updated
03/04/2008
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