MEDICARE: DR. DALE E FAHIE D.O.F.A.C.O.F.P.

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	207Q00000X	Family Medicine Physician	OS-06925	FL
2	207QA0000X	Adolescent Medicine (Family Medicine) Physician	OS-6925	FL
3	207QA0505X	Adult Medicine Physician	OS-6925	FL
4	207QG0300X	Geriatric Medicine (Family Medicine) Physician	OS-6925	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1073790333	OTHER	FL	N.A.F.F.I. DBA FOY'S MEDICAL CENTER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	592115487	OTHER	FL	TAX ID N.A.F.F.I. INC DBA

General Provider Information

NPI Number	:	1619921962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE E FAHIE D.O.F.A.C.O.F.P.

Provider Business Mailing Address
First Line	:	17320 SW 32ND CT
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33029-5591
Country	:	US
Telephone Number	:	954-202-9948
Fax Number	:	954-202-7399

Provider Business Practice Location Address
First Line	:	4600 NORTH FEDERAL HIGHWAY
Second Line	:	FOY'S MEDICAL CENTER
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5206
Country	:	US
Telephone Number	:	954-202-9948
Fax Number	:	954-202-7399

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

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	02/06/2013

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