Provider Demographics
NPI:1134138019
Name:JHAVERI, FAIYAAZ MUSTANSIR (MD)
Entity Type:Individual
Prefix:DR
First Name:FAIYAAZ
Middle Name:MUSTANSIR
Last Name:JHAVERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:105 PARK PLACE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-6870
Mailing Address - Country:US
Mailing Address - Phone:863-419-2165
Mailing Address - Fax:863-419-2166
Practice Address - Street 1:105 PARK PLACE BLVD STE A
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-6870
Practice Address - Country:US
Practice Address - Phone:863-419-2165
Practice Address - Fax:863-419-2166
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0080612208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL217235OtherAMERIGROUP
FL340018541OtherRAILROAD MEDICARE
FL164139OtherSTAYWELL
FL35713OtherBCBS
FL35713OtherBCBS
FLG73690Medicare UPIN