Provider Demographics
NPI:1205884178
Name:MEHMOOD, FARHAT (MD)
Entity type:Individual
Prefix:
First Name:FARHAT
Middle Name:
Last Name:MEHMOOD
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 1:5005 AVOCET LN
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-8082
Mailing Address - Country:US
Mailing Address - Phone:205-427-7320
Mailing Address - Fax:
Practice Address - Street 1:129 E REDSTONE AVE STE A
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5350
Practice Address - Country:US
Practice Address - Phone:850-682-7212
Practice Address - Fax:850-682-0220
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021666207R00000X
WI49357207R00000X
KYC3898207RC0001X
FLME110965207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009936574Medicaid
AL009936574Medicaid