Provider Demographics
NPI:1356442776
Name:EFTEKHARI, NASSER (MD PA)
Entity Type:Individual
Prefix:DR
First Name:NASSER
Middle Name:
Last Name:EFTEKHARI
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 SW 112 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-4850
Mailing Address - Country:US
Mailing Address - Phone:305-206-4726
Mailing Address - Fax:305-661-3844
Practice Address - Street 1:6301 SW 112 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-4850
Practice Address - Country:US
Practice Address - Phone:305-206-4726
Practice Address - Fax:305-661-3844
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050316208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059446600Medicaid
FL059446600Medicaid
E30534Medicare UPIN