Provider Demographics
NPI:1598791782
Name:ALFARRA, FAWAZ (MD)
Entity Type:Individual
Prefix:
First Name:FAWAZ
Middle Name:
Last Name:ALFARRA
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 1:2901 CORAL HILLS DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4146
Mailing Address - Country:US
Mailing Address - Phone:954-753-3355
Mailing Address - Fax:954-345-0487
Practice Address - Street 1:9871 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4005
Practice Address - Country:US
Practice Address - Phone:954-753-3355
Practice Address - Fax:954-345-0487
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070217174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF90244Medicare UPIN
FL31719YMedicare PIN