Healthcare Provider Details

I. General information

NPI: 1497850556
Provider Name (Legal Business Name): FARJAM FARZAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12959 PALMS WEST DR SUITE 120
LOXAHATCHEE FL
33470-4937
US

IV. Provider business mailing address

12959 PALMS WEST DR SUITE 120
LOXAHATCHEE FL
33470-4937
US

V. Phone/Fax

Practice location:
  • Phone: 561-753-8888
  • Fax: 561-795-5004
Mailing address:
  • Phone: 561-753-8888
  • Fax: 561-795-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME116217
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: