Healthcare Provider Details

I. General information

NPI: 1790180479
Provider Name (Legal Business Name): SAFA LOHRASBI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2014
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SE HOSPITAL AVE
STUART FL
34994-2346
US

IV. Provider business mailing address

801 SE JOHNSON AVE PO BOX 2678
STUART FL
34994-4854
US

V. Phone/Fax

Practice location:
  • Phone: 772-288-7520
  • Fax:
Mailing address:
  • Phone: 509-594-5633
  • Fax: 509-594-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number60560
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number299257
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20083
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: