Provider Demographics
NPI:1841339108
Name:FARES, RIYAD (MD)
Entity type:Individual
Prefix:DR
First Name:RIYAD
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 1:2311 NW NORTHRUP ST STE 209
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2955
Mailing Address - Country:US
Mailing Address - Phone:503-446-1965
Mailing Address - Fax:503-447-2760
Practice Address - Street 1:2311 NW NORTHRUP ST STE 209
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2955
Practice Address - Country:US
Practice Address - Phone:503-446-1965
Practice Address - Fax:503-447-2760
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine