Provider Demographics
NPI:1912599515
Name:FAWZI FARHA MD INC
Entity Type:Organization
Organization Name:FAWZI FARHA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAWZI
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-368-1231
Mailing Address - Street 1:7777 MOUNT RANIER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-3901
Mailing Address - Country:US
Mailing Address - Phone:904-368-1231
Mailing Address - Fax:
Practice Address - Street 1:7777 MOUNT RANIER DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-3901
Practice Address - Country:US
Practice Address - Phone:904-368-1231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty