Provider Demographics
NPI:1720205511
Name:FARID, WAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:WAEL
Middle Name:
Last Name:FARID
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:PO BOX 16528
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-6528
Mailing Address - Country:US
Mailing Address - Phone:850-640-3259
Mailing Address - Fax:850-640-3262
Practice Address - Street 1:282 FOREST PARK CIR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4919
Practice Address - Country:US
Practice Address - Phone:850-640-3259
Practice Address - Fax:850-640-3262
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99885207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL280906100Medicaid