Provider Demographics
NPI:1982781860
Name:FAZZANO, FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:
Last Name:FAZZANO
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 1:1801 N UNIVERSITY DR
Mailing Address - Street 2:201
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8920
Mailing Address - Country:US
Mailing Address - Phone:954-755-1411
Mailing Address - Fax:954-755-8315
Practice Address - Street 1:1801 N UNIVERSITY DR
Practice Address - Street 2:201
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8920
Practice Address - Country:US
Practice Address - Phone:954-755-1411
Practice Address - Fax:954-755-8315
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43613207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0488467900Medicaid
94389Medicare ID - Type Unspecified
FL0488467900Medicaid