Provider Demographics
NPI:1871584292
Name:LURIE, FAYVA (MD)
Entity type:Individual
Prefix:
First Name:FAYVA
Middle Name:
Last Name:LURIE
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 1:5162 LINTON BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6567
Mailing Address - Country:US
Mailing Address - Phone:561-637-5780
Mailing Address - Fax:561-637-7573
Practice Address - Street 1:5162 LINTON BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6567
Practice Address - Country:US
Practice Address - Phone:561-637-5780
Practice Address - Fax:561-637-7573
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G17690Medicare UPIN
FL28245Medicare ID - Type Unspecified