Healthcare Provider Details

I. General information

NPI: 1205884178
Provider Name (Legal Business Name): FARHAT MEHMOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 E REDSTONE AVE STE A
CRESTVIEW FL
32539-5350
US

IV. Provider business mailing address

5005 AVOCET LN
PENSACOLA FL
32514-8082
US

V. Phone/Fax

Practice location:
  • Phone: 850-682-7212
  • Fax: 850-682-0220
Mailing address:
  • Phone: 205-427-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00021666
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49357
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberC3898
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME110965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: