Provider Demographics
NPI:1497850556
Name:FARZAM, FARJAM (MD)
Entity Type:Individual
Prefix:
First Name:FARJAM
Middle Name:
Last Name:FARZAM
Suffix:
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 1:12959 PALMS WEST DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4937
Mailing Address - Country:US
Mailing Address - Phone:561-753-8888
Mailing Address - Fax:561-795-5004
Practice Address - Street 1:12959 PALMS WEST DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4937
Practice Address - Country:US
Practice Address - Phone:561-753-8888
Practice Address - Fax:561-795-5004
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1162172084N0402X
KY393522084P0804X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64096589Medicaid
FL009333600Medicaid
FL009333600Medicaid