MEDICARE: FAWZI FARHA MD INC

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	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912599515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAWZI FARHA MD INC

Provider Business Mailing Address
First Line	:	206 ASHOURIAN AVE STE 213
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5107
Country	:	US
Telephone Number	:	904-990-0777
Fax Number	:	888-464-0609

Provider Business Practice Location Address
First Line	:	206 ASHOURIAN AVE STE 213
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5107
Country	:	US
Telephone Number	:	904-990-0777
Fax Number	:	888-464-0609

Authorized Official
Title or Position	:	OWNER
Name	:	FAWZI S FARHA
Credential	:	MD
Telephone Number	:	904-990-0777

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	11/07/2024

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