| Russell W Faria DO PC | |
|
15215 Se 272nd St Ste 103 Kent WA 98042-4215 | |
| (253) 639-1883 | |
| (253) 639-1891 |
| Full Name | Russell W Faria DO PC |
|---|---|
| Speciality | Family Medicine |
| Location | 15215 Se 272nd St Ste 103, Kent, Washington |
| Authorized Official Name and Position | Trish Bukauskas (BILLING MGR) |
| Authorized Official Contact | 8432939966 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell W Faria DO PC 15215 Se 272nd St Ste 103 Kent WA 98042-4215 Ph: (253) 639-1883 | Russell W Faria DO PC 15215 Se 272nd St Ste 103 Kent WA 98042-4215 Ph: (253) 639-1883 |
| NPI Number | 1457521619 |
|---|---|
| Provider Enumeration Date | 03/04/2008 |
| Last Update Date | 03/04/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457521619 | NPI | - | NPPES |
| 150278 | Medicaid | OR | |
| D020354 | Other | OR | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D020354 (Oregon) | Primary |
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