Provider Demographics
NPI:1669660890
Name:FARAHMAND PLASTIC SURGERY P.L.
Entity Type:Organization
Organization Name:FARAHMAND PLASTIC SURGERY P.L.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAHMAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-332-2388
Mailing Address - Street 1:13710 METROPOLIS AVE
Mailing Address - Street 2:UNIT 104
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-7144
Mailing Address - Country:US
Mailing Address - Phone:239-332-2388
Mailing Address - Fax:239-332-2382
Practice Address - Street 1:13710 METROPOLIS AVE
Practice Address - Street 2:UNIT 104
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-7144
Practice Address - Country:US
Practice Address - Phone:239-332-2388
Practice Address - Fax:239-332-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89962208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7952Medicare PIN