Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 217452 | NY |
N | 207P00000X | Emergency Physician | ME81763 | FL |
Y | 207Q00000X | Family Doctor | ME81763 | FL |
NPI | 1003885815 |
---|---|
Provider Name | Nagy Saber Farag |
First Address | Port St Lucie, FL 34952-1401 |
Second Address | Port St Lucie, FL 34952-1401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 01/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H38712 | (02) |