Healthcare Provider Details

I. General information

NPI: 1023051265
Provider Name (Legal Business Name): FARID ASSOUAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 GLADES RD STE 100
BOCA RATON FL
33434-4150
US

IV. Provider business mailing address

7777 GLADES RD STE 100
BOCA RATON FL
33434-4150
US

V. Phone/Fax

Practice location:
  • Phone: 561-573-3495
  • Fax: 888-910-3040
Mailing address:
  • Phone: 561-573-3495
  • Fax: 888-910-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301079607
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME98413
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301079607
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME98413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: