1922285998 NPI number — DR. PARHAM EFTEKHARI D.O.

Table of content: DR. PARHAM EFTEKHARI D.O. (NPI 1922285998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922285998 NPI number — DR. PARHAM EFTEKHARI D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EFTEKHARI
Provider First Name:
PARHAM
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922285998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 SE 9TH ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33316-1113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-463-0112
Provider Business Mailing Address Fax Number:
954-463-0117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 SE 9TH STREET
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-463-0112
Provider Business Practice Location Address Fax Number:
954-463-0117
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  FS OS11227 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003502800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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