Provider Demographics
NPI:1457610305
Name:ROBINSON-FARAH, GRAHAM (MD)
Entity type:Individual
Prefix:
First Name:GRAHAM
Middle Name:
Last Name:ROBINSON-FARAH
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 1:28149 HWY 27
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:FL
Mailing Address - Zip Code:33838-4274
Mailing Address - Country:US
Mailing Address - Phone:631-885-5669
Mailing Address - Fax:863-438-9095
Practice Address - Street 1:28149 HWY 27
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:FL
Practice Address - Zip Code:33838-4274
Practice Address - Country:US
Practice Address - Phone:631-885-5669
Practice Address - Fax:863-438-9095
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-13
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME114058207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program