Healthcare Provider Details

I. General information

NPI: 1053873745
Provider Name (Legal Business Name): FAREED RIFAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 N DAVIS HWY
PENSACOLA FL
32504-6950
US

IV. Provider business mailing address

6100 N DAVIS HWY
PENSACOLA FL
32504-6950
US

V. Phone/Fax

Practice location:
  • Phone: 850-607-6841
  • Fax: 850-637-1054
Mailing address:
  • Phone: 850-607-6841
  • Fax: 850-637-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberME164034
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number57632
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: