MEDICARE: ALI CANTON VAFABAKHSH 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	2084P0800X	Psychiatry Physician	ME119540	FL

General Provider Information

NPI Number	:	1578857595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI CANTON VAFABAKHSH MD

Provider Business Mailing Address
First Line	:	8491 NW 39TH AVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-5635
Country	:	US
Telephone Number	:	352-265-7981
Fax Number	:

Provider Business Practice Location Address
First Line	:	8491 NW 39TH AVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-5635
Country	:	US
Telephone Number	:	352-265-7981
Fax Number	:

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

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	06/18/2014

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