Individual
FARES A. KOKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508-0001
(254) 724-5437
Mailing address
PO BOX 8844658, DALLAS, TX 75284-0001
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
L5419
TX
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
L5419
TX
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
L5419
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162381101
—
TX
01
—
162381102
CSHCN NUMBER
TX
01
—
8F2086
BC/BS OF TEXAS
TX
Enumeration date
08/23/2006
Last updated
07/03/2014
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