Healthcare Provider Details

I. General information

NPI: 1497289326
Provider Name (Legal Business Name): GRAHAM ROBINSON-FARAH MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 HART LAKE ST
WINTER HAVEN FL
33884-4160
US

IV. Provider business mailing address

818 HART LAKE ST
WINTER HAVEN FL
33884-4160
US

V. Phone/Fax

Practice location:
  • Phone: 631-885-5669
  • Fax:
Mailing address:
  • Phone: 631-885-5669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME114058
License Number StateFL

VIII. Authorized Official

Name: GRAHAM ROBINSON-FARAH
Title or Position: CEO
Credential: MD
Phone: 631-885-5669