MEDICARE: FAYVA LURIE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME65912	FL

General Provider Information

NPI Number	:	1871584292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAYVA LURIE MD

Provider Business Mailing Address
First Line	:	5162 LINTON BLVD
Second Line	:	SUITE 103
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6567
Country	:	US
Telephone Number	:	561-637-5780
Fax Number	:	561-637-7573

Provider Business Practice Location Address
First Line	:	5162 LINTON BLVD
Second Line	:	SUITE 103
City	:	DELRAY BEACH
State	:	FL
Zip	:	33484-6567
Country	:	US
Telephone Number	:	561-637-5780
Fax Number	:	561-637-7573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	04/17/2013

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Directions to “ FAYVA LURIE MD” Practice Location

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