Provider Demographics
NPI:1790821965
Name:FAIERMAN, TAMY (MD)
Entity Type:Individual
Prefix:
First Name:TAMY
Middle Name:
Last Name:FAIERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 E COQUINA WAY
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33332-2483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17130 ROYAL PALM BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2311
Practice Address - Country:US
Practice Address - Phone:954-322-2742
Practice Address - Fax:954-384-5434
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84189174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH21878Medicare UPIN