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General NPI Number Information
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NPI Number | 1508112202
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Entity Type | Organization
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Legal Business Name | FARIS J. FAKHOURY, MD, PA
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Dates
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Enumeration Date | 07/31/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 10115 FOREST HILL BLVD SUITE 405
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City | WELLINGTON
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State | FL
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Zip | 33414-3105
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Country | US
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Telephone | 561-791-3070
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Fax | 561-791-3080
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Provider Business Mailing Address
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Address Line | 11101 S CROWN WAY SUITE 1
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City | WELLINGTON
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State | FL
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Zip | 33414-8792
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Country | US
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Telephone | 561-795-9150
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Fax | 561-798-7700
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Authorized Official
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Title or Position | PRESIDENT
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Name | FARIS J. FAKHOURY
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Credential | M.D.
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Telephone | 561-791-3070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME106083
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License Number State | FL
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