Healthcare Provider Details

I. General information

NPI: 1134233182
Provider Name (Legal Business Name): F DEAN FAGHIH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13525 BAY LAKE LANE
TAMPA FL
33618
US

IV. Provider business mailing address

PO BOX 272688
TAMPA FL
33688
US

V. Phone/Fax

Practice location:
  • Phone: 813-956-3388
  • Fax:
Mailing address:
  • Phone: 813-956-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number48145
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: