Individual
DR. KEVIN JAY FARIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
205 S MAIN ST, NOBLE, OK 73068-9623
(405) 872-5403
(405) 872-5407
Mailing address
PO BOX 2096, NOBLE, OK 73068-2096
(405) 872-5403
(405) 872-5407
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
16675
OK
207R00000X
Internal Medicine Physician
N3025
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100130750A
—
OK
01
—
110186683
RAILROAD MEDICARE
OK
01
—
400522556
MEDICARE GRP #
OK
Enumeration date
02/02/2006
Last updated
03/04/2020
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