Provider Demographics
NPI:1619921962
Name:FAHIE, DALE E (DOFACOFP)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:E
Last Name:FAHIE
Suffix:
Gender:M
Credentials:DOFACOFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17320 SW 32ND CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5591
Mailing Address - Country:US
Mailing Address - Phone:954-202-9948
Mailing Address - Fax:954-202-7399
Practice Address - Street 1:4600 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:FOY'S MEDICAL CENTER
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5206
Practice Address - Country:US
Practice Address - Phone:954-202-9948
Practice Address - Fax:954-202-7399
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-06925207Q00000X
FLOS-6925207QA0000X, 207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1073790333OtherN.A.F.F.I. DBA FOY'S MEDICAL CENTER
FL251207600Medicaid
FL592115487OtherTAX ID N.A.F.F.I. INC DBA
FL57395Medicare ID - Type Unspecified
FL592115487OtherTAX ID N.A.F.F.I. INC DBA
FL251207600Medicaid