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General NPI Number Information
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NPI Number | 1548299712
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Entity Type | Individual
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Provider Name | FARIBORZ DELBAKHSH M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 10770 SE 173RD ST
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City | SUMMERFIELD
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State | FL
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Zip | 34491-6851
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Country | US
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Telephone | 352-307-9515
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Fax | 352-307-7848
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Provider Business Mailing Address
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Address Line | 10770 SE 173RD ST
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City | SUMMERFIELD
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State | FL
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Zip | 34491-6851
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Country | US
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Telephone | 352-307-9515
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Fax | 352-307-7848
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME79659
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License Number State | FL
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