Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 19455 | NH |
N | 111NI0900X | Internist | 19455 | NH |
N | 207R00000X | Internist | 231707 | MA |
N | 111NI0900X | Internist | 231707 | MA |
Y | 207RX0202X | Medical Oncology | 19455 | NH |
N | 207RX0202X | Medical Oncology | 231707 | MA |
NPI | 1134255813 |
---|---|
Provider Name | Jason Edward Faris |
First Address | Lebanon, NH 03756 |
Second Address | Lebanon, NH 03756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 22/04/2019 |