Provider Demographics
NPI:1801676531
Name:WHITE SANDS MEDICAL GROUP
Entity type:Organization
Organization Name:WHITE SANDS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:BRAD
Authorized Official - Last Name:MOZAFFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-647-8825
Mailing Address - Street 1:1702 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4290
Mailing Address - Country:US
Mailing Address - Phone:850-647-8825
Mailing Address - Fax:
Practice Address - Street 1:1702 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4290
Practice Address - Country:US
Practice Address - Phone:850-647-8825
Practice Address - Fax:850-248-8825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-02
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty