Provider Demographics
NPI:1477532463
Name:FARHA, FAWZI SOUHEIL (MD)
Entity type:Individual
Prefix:
First Name:FAWZI
Middle Name:SOUHEIL
Last Name:FARHA
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 1:206 ASHOURIAN AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-5107
Mailing Address - Country:US
Mailing Address - Phone:904-990-0777
Mailing Address - Fax:888-464-0609
Practice Address - Street 1:206 ASHOURIAN AVE STE 213
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-5107
Practice Address - Country:US
Practice Address - Phone:904-990-0777
Practice Address - Fax:888-464-0609
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLI40882208600000X
FLME92741208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5714AMedicare ID - Type Unspecified