Healthcare Provider Details

I. General information

NPI: 1356442776
Provider Name (Legal Business Name): NASSER EFTEKHARI MD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 SW 112 ST
MIAMI FL
33156-4850
US

IV. Provider business mailing address

6301 SW 112 ST
MIAMI FL
33156-4850
US

V. Phone/Fax

Practice location:
  • Phone: 305-206-4726
  • Fax: 305-661-3844
Mailing address:
  • Phone: 305-206-4726
  • Fax: 305-661-3844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME0050316
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: