Active NPI
Khallad A Fares, M.D.
- Surgery Physician
- Palatka, FL
National Provider Identifier
1922076165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- ME75536
- Practice address
- 800 Zeagler Dr
Suite 320
Palatka, FL 32177-3883 - Phone
- (386) 328-9977
- Fax
- (386) 329-1953
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | ME75536 | FL | Primary |
Addresses
Primary practice location
800 Zeagler Dr
Suite 320
Palatka, FL 32177-3883
Mailing address
800 Zeagler Dr
Suite 320
Palatka, FL 32177-3883
Phone (386) 328-9977
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME75536 | FL | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Red Bud Clinic Corp | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Red Bud, IL
- NPI 1083617609
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922076165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 ZEAGLER DR",
"address_2": "SUITE 320",
"city": "PALATKA",
"state": "FL",
"postal_code": "321773883",
"telephone_number": "386-328-9977",
"fax_number": "386-329-1953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 ZEAGLER DR",
"address_2": "SUITE 320",
"city": "PALATKA",
"state": "FL",
"postal_code": "321773883",
"telephone_number": "386-328-9977",
"fax_number": "386-329-1953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARES",
"first_name": "KHALLAD",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "FL",
"license": "ME75536",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palatka, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.