Provider Demographics
NPI:1922285998
Name:EFTEKHARI, PARHAM (DO)
Entity Type:Individual
Prefix:DR
First Name:PARHAM
Middle Name:
Last Name:EFTEKHARI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 SE 9TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-1113
Mailing Address - Country:US
Mailing Address - Phone:954-463-0112
Mailing Address - Fax:954-463-0117
Practice Address - Street 1:407 SE 9TH STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-463-0112
Practice Address - Fax:954-463-0117
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFS OS11227207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003502800Medicaid
FLEZ723ZMedicare PIN