MEDICARE: FAWZI SOUHEIL FARHA MD

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
1	208600000X	Surgery Physician	I40882	FL
2	208600000X	Surgery Physician	ME92741	FL

General Provider Information

NPI Number	:	1477532463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAWZI SOUHEIL FARHA MD

Provider Business Mailing Address
First Line	:	206 ASHOURIAN AVE STE 213
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5107
Country	:	US
Telephone Number	:	904-990-0777
Fax Number	:	888-464-0609

Provider Business Practice Location Address
First Line	:	206 ASHOURIAN AVE STE 213
Second Line	:
City	:	SAINT AUGUSTINE
State	:	FL
Zip	:	32092-5107
Country	:	US
Telephone Number	:	904-990-0777
Fax Number	:	888-464-0609

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	11/07/2024

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Directions to “ FAWZI SOUHEIL FARHA MD” Practice Location

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