Healthcare Provider Details

I. General information

NPI: 1376603803
Provider Name (Legal Business Name): IRAJ NIKFARJAM SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 SE 28TH LOOP STE 102
OCALA FL
34471-5328
US

IV. Provider business mailing address

1725 SE 28TH LOOP STE 102
OCALA FL
34471-5328
US

V. Phone/Fax

Practice location:
  • Phone: 352-629-1743
  • Fax: 352-690-6954
Mailing address:
  • Phone: 352-629-1743
  • Fax: 352-690-2171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2011-01233
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberME128379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: