Healthcare Provider Details

I. General information

NPI: 1437104577
Provider Name (Legal Business Name): JACQUES NATHAN FARKAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 W COPELAND DR
ORLANDO FL
32806-2002
US

IV. Provider business mailing address

521 W STATE ROAD 434 STE 301
LONGWOOD FL
32750-5166
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7550
  • Fax: 321-841-8185
Mailing address:
  • Phone: 321-841-7550
  • Fax: 321-841-8185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME53374
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME53374
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME53374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: