Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301079607 | MI |
N | 111NI0900X | Internist | 4301079607 | MI |
Y | 207R00000X | Internist | ME98413 | FL |
Y | 111NI0900X | Internist | ME98413 | FL |
N | 207RG0300X | Geriatric Medicine | 4301079607 | MI |
N | 207RG0300X | Geriatric Medicine | ME98413 | FL |
NPI | 1023051265 |
---|---|
Provider Name | Farid Assouad |
First Address | Boca Raton, FL 33434-4150 |
Second Address | Boca Raton, FL 33434-4150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 21/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1019481 | MCLAREN HEALTH PLAN (01) | MI |
1020018 | MCLAREN HEALTH PLAN (01) | MI |
110591010 | BCBSM (01) | MI |
278681800 | (05) | FL |
4803597 | (05) | MI |
4803603 | (05) | MI |
4948825-10 | (05) | MI |
H97940 | (02) | MI |