NPIMap

Organization Active NPI

Wissam Fayad MD PC

  • Preferred Provider Organization
  • Yuma, AZ
National Provider Identifier
1396058954
Registry record updated Jul 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
35717 Issued in AZ
Legal business name
WISSAM FAYAD MD PC
Doing business as
Wissam Fayad MD PC
Practice address
1841 W 25TH St
Suite a
Yuma, AZ 85364-6920
Phone
(928) 344-5565
Fax
(928) 344-5655
NPI assigned
Jul 23, 2010
Last updated
Jul 23, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wissam A Fayad, M.D.NPI 1902841810
Title
MD/Doctor
Phone
(928) 344-5565

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 35717 AZ Primary

Addresses

Primary practice location

1841 W 25TH St
Suite a
Yuma, AZ 85364-6920

Mailing address

1841 W 25TH St
Suite a
Yuma, AZ 85364-6920
Phone (928) 344-5565

Other identifiers 1

IdentifierTypeStateIssuer
127146-003MedicaidAZ

Other names 1

  • Wissam Fayad MD PC Doing business as

National Provider Directory

National Provider Directory

Locations

1841 W 25th St
Ste A
Yuma, AZ 85364
Phone (928) 341-1300

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1279843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279843200000",
    "number": "1396058954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1841 W 25TH ST",
            "address_2": "SUITE A",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853646920",
            "telephone_number": "928-344-5565",
            "fax_number": "928-344-5655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1841 W 25TH ST",
            "address_2": "SUITE A",
            "city": "YUMA",
            "state": "AZ",
            "postal_code": "853646920",
            "telephone_number": "928-344-5565",
            "fax_number": "928-344-5655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISSAM FAYAD MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-23",
        "last_updated": "2010-07-23",
        "status": "A",
        "authorized_official_last_name": "FAYAD",
        "authorized_official_first_name": "WISSAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MD/DOCTOR",
        "authorized_official_telephone_number": "928-344-5565",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "AZ",
            "license": "35717",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127146-003",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wissam Fayad MD PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yuma, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.