Provider Demographics
NPI:1003885815
Name:FARAG, NAGY SABER
Entity Type:Individual
Prefix:
First Name:NAGY
Middle Name:SABER
Last Name:FARAG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7043 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1401
Mailing Address - Country:US
Mailing Address - Phone:727-309-1412
Mailing Address - Fax:
Practice Address - Street 1:7043 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1401
Practice Address - Country:US
Practice Address - Phone:727-309-1412
Practice Address - Fax:352-564-4222
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217452207P00000X
FLME81763207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIJ529ZMedicare PIN
H38712Medicare UPIN