MEDICARE: DR. EDWARD H. FARRIOR M.D., F.A.C.S

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	207YS0123X	Facial Plastic Surgery Physician	ME50318	FL
2	2082S0099X	Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician	ME50318	FL

General Provider Information

NPI Number	:	1518052430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD H. FARRIOR M.D., F.A.C.S

Provider Business Mailing Address
First Line	:	2908 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3110
Country	:	US
Telephone Number	:	813-875-3223
Fax Number	:	813-875-5586

Provider Business Practice Location Address
First Line	:	2908 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3110
Country	:	US
Telephone Number	:	813-875-3223
Fax Number	:	813-875-5586

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/29/2015

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