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General NPI Number Information
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NPI Number | 1912599515
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Entity Type | Organization
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Legal Business Name | FAWZI FARHA MD INC
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Dates
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Enumeration Date | 02/05/2021
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 206 ASHOURIAN AVE STE 213
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-5107
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Country | US
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Telephone | 904-990-0777
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Fax | 888-464-0609
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Provider Business Mailing Address
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Address Line | 206 ASHOURIAN AVE STE 213
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32092-5107
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Country | US
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Telephone | 904-990-0777
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Fax | 888-464-0609
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Authorized Official
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Title or Position | OWNER
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Name | FAWZI S FARHA
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Credential | MD
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Telephone | 904-990-0777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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