Provider Demographics
NPI:1124055306
Name:SIDDIQI, FARHAN NAVEED (MD)
Entity type:Individual
Prefix:DR
First Name:FARHAN
Middle Name:NAVEED
Last Name:SIDDIQI
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 1:2040 SHORT AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3427
Mailing Address - Country:US
Mailing Address - Phone:727-372-9922
Mailing Address - Fax:
Practice Address - Street 1:2040 SHORT AVE STE 100
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3445
Practice Address - Country:US
Practice Address - Phone:727-372-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD006034207XS0117X
FLME96330207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
L1006Medicare ID - Type Unspecified
FL6079770002Medicare NSC
I37453Medicare UPIN