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NPI Code Detail

MEDICARE: MOHAMMAD IBRAHIM FARDOS

MEDICARE: MOHAMMAD IBRAHIM FARDOS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician23826FL

General Provider Information

NPI Number : 1104575588
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOHAMMAD IBRAHIM FARDOS
Provider Business Mailing Address
First Line : 8220 US HIGHWAY 19
Second Line :
City : PORT RICHEY
State : FL
Zip : 34668-6639
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8220 US HIGHWAY 19
Second Line :
City : PORT RICHEY
State : FL
Zip : 34668-6639
Country : US
Telephone Number : 727-588-5704
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2022
Last Update Date : 06/03/2026

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Directions to “ MOHAMMAD IBRAHIM FARDOS ” Practice Location

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