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NPI Code Detail

MEDICARE: ALEXANDER FARIBORZIAN MD

MEDICARE: ALEXANDER FARIBORZIAN 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
12084P0800XPsychiatry PhysicianME 90406FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710045539
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDER FARIBORZIAN MD
Provider Business Mailing Address
First Line : 1753 KINGSLEY AVE
Second Line : SUITE 2
City : ORANGE PARK
State : FL
Zip : 32073-4411
Country : US
Telephone Number : 904-278-5644
Fax Number : 904-278-5659
Provider Business Practice Location Address
First Line : 3292 COUNTY ROAD 220
Second Line :
City : MIDDLEBURG
State : FL
Zip : 32068-4357
Country : US
Telephone Number : 904-291-5561
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 01/06/2020

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