Provider Demographics
NPI:1508112202
Name:FARIS J. FAKHOURY, MD, PA
Entity Type:Organization
Organization Name:FARIS J. FAKHOURY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAKHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-791-3070
Mailing Address - Street 1:11101 S CROWN WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8792
Mailing Address - Country:US
Mailing Address - Phone:561-795-9150
Mailing Address - Fax:561-798-7700
Practice Address - Street 1:10115 FOREST HILL BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3105
Practice Address - Country:US
Practice Address - Phone:561-791-3070
Practice Address - Fax:561-791-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106083207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty