Provider Demographics
NPI:1902891302
Name:FARES, EMILE (MD)
Entity Type:Individual
Prefix:
First Name:EMILE
Middle Name:
Last Name:FARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7338 MCHENRY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-3633
Mailing Address - Country:US
Mailing Address - Phone:713-644-4442
Mailing Address - Fax:713-644-8964
Practice Address - Street 1:7338 MCHENRY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-3633
Practice Address - Country:US
Practice Address - Phone:713-644-4442
Practice Address - Fax:713-644-8964
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2254207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX333487201Medicaid
TX333487202Medicaid
TX137924012Medicaid
TX333487202Medicaid