Provider Demographics
NPI:1871713651
Name:GHAZI-TEHRANI, FARAMARZ H (MD)
Entity type:Individual
Prefix:DR
First Name:FARAMARZ
Middle Name:H
Last Name:GHAZI-TEHRANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FARAMARZ
Other - Middle Name:H
Other - Last Name:GHAZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1425 S US 301
Mailing Address - Street 2:
Mailing Address - City:SUMTERVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:33585-5141
Mailing Address - Country:US
Mailing Address - Phone:352-793-5900
Mailing Address - Fax:
Practice Address - Street 1:151 E HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4846
Practice Address - Country:US
Practice Address - Phone:352-722-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44247208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038063600Medicaid
FL36392OtherMEDICARE PTAN
FLME44247OtherFLORIDA LICENSE
FLD21551Medicare UPIN
FL36392Medicare ID - Type Unspecified