Provider Demographics
NPI:1376732453
Name:FIRAZ R HOSEIN DO PA
Entity Type:Organization
Organization Name:FIRAZ R HOSEIN DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FIRAZ
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HOSEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-782-3170
Mailing Address - Street 1:P. O. BOX 970465
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33097-0465
Mailing Address - Country:US
Mailing Address - Phone:954-782-3170
Mailing Address - Fax:954-782-3171
Practice Address - Street 1:1 W SAMPLE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-782-3170
Practice Address - Fax:954-782-3171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8550207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268249400Medicaid
FL268249400Medicaid