MEDICARE: LISA FERAYORNI 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	207RG0100X	Gastroenterology Physician	ME66954	FL

General Provider Information

NPI Number	:	1922431840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA FERAYORNI MD

Provider Business Mailing Address
First Line	:	1837 NE 26TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-3564
Country	:	US
Telephone Number	:	954-566-1266
Fax Number	:

Provider Business Practice Location Address
First Line	:	1837 NE 26TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-3564
Country	:	US
Telephone Number	:	954-566-1266
Fax Number	:

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

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/14/2013

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Directions to “ LISA FERAYORNI MD” Practice Location

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