Provider Demographics
NPI:1376603803
Name:NIKFARJAM, IRAJ SR (MD)
Entity Type:Individual
Prefix:
First Name:IRAJ
Middle Name:
Last Name:NIKFARJAM
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 SE 28TH LOOP STE 102
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5328
Mailing Address - Country:US
Mailing Address - Phone:352-629-1743
Mailing Address - Fax:352-690-2171
Practice Address - Street 1:1725 SE 28TH LOOP STE 102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5328
Practice Address - Country:US
Practice Address - Phone:352-629-1743
Practice Address - Fax:352-690-6954
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-012332084N0400X
FLME1283792085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology