Provider Demographics
NPI:1851347868
Name:JAVIER FARACH MD, PA
Entity Type:Organization
Organization Name:JAVIER FARACH MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:JAVIER
Authorized Official - Last Name:FARACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-615-3838
Mailing Address - Street 1:1545 HAND AVE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1139
Mailing Address - Country:US
Mailing Address - Phone:386-615-3838
Mailing Address - Fax:386-615-3848
Practice Address - Street 1:1545 HAND AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1139
Practice Address - Country:US
Practice Address - Phone:386-615-3838
Practice Address - Fax:386-615-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9159Medicare PIN