Individual
DR. TONY FARIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901-3224
(321) 434-1771
(321) 434-1775
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(321) 434-1771
(321) 951-7408
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02006019A
IN
207R00000X
Internal Medicine Physician
UO4459
FL
208M00000X
Hospitalist Physician
Primary
OS14279
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100849600
—
FL
01
—
KH035
MEDICARE
FL
Enumeration date
07/07/2015
Last updated
06/03/2020
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