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NPI Code Detail

MEDICARE: DR. MOHAMMAD FAROOQUE M.D., PH.D.

MEDICARE: DR. MOHAMMAD FAROOQUE M.D., PH.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program2005013889MO
22084P0800XPsychiatry PhysicianME100550FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21455POTHERFLBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1730100587
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MOHAMMAD FAROOQUE M.D., PH.D.
Provider Business Mailing Address
First Line : 10175 FORTUNE PKWY
Second Line : SUITE #1106
City : JACKSONVILLE
State : FL
Zip : 32256-6746
Country : US
Telephone Number : 904-379-5928
Fax Number : 904-379-5967
Provider Business Practice Location Address
First Line : 10175 FORTUNE PKWY
Second Line : SUITE #1106
City : JACKSONVILLE
State : FL
Zip : 32256-6746
Country : US
Telephone Number : 904-379-5928
Fax Number : 904-379-5967
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 03/18/2014

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