Provider Demographics
NPI:1619126059
Name:DIABETES THYROID AND ENDOCRINOLOGY CENTER PL
Entity Type:Organization
Organization Name:DIABETES THYROID AND ENDOCRINOLOGY CENTER PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TALAL
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-868-3200
Mailing Address - Street 1:7414 COMMUNITY CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7101
Mailing Address - Country:US
Mailing Address - Phone:727-868-3200
Mailing Address - Fax:727-868-3204
Practice Address - Street 1:7414 COMMUNITY CT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7101
Practice Address - Country:US
Practice Address - Phone:727-868-3200
Practice Address - Fax:727-868-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78645207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDO9834OtherRR MEDICARE
FL001069200Medicaid
FLDO9834OtherRR MEDICARE
FL001069200Medicaid