Healthcare Provider Details

I. General information

NPI: 1982603965
Provider Name (Legal Business Name): FARHAT SELIM KHAIRALLAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CENTERVILLE RD
TALLAHASSEE FL
32308-4379
US

IV. Provider business mailing address

1300 MEDICAL DR
TALLAHASSEE FL
32308-4646
US

V. Phone/Fax

Practice location:
  • Phone: 850-216-0100
  • Fax: 850-216-0138
Mailing address:
  • Phone: 850-216-0100
  • Fax: 850-216-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME90702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: