Provider Demographics
NPI:1194720771
Name:BEHFAR, KASRA N
Entity type:Individual
Prefix:
First Name:KASRA
Middle Name:N
Last Name:BEHFAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 NW 33RD ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4042
Mailing Address - Country:US
Mailing Address - Phone:954-726-9255
Mailing Address - Fax:954-720-5945
Practice Address - Street 1:9750 NW 33RD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4042
Practice Address - Country:US
Practice Address - Phone:954-726-9255
Practice Address - Fax:954-720-5945
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2011-10-26
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
FLPO2505213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390287100Medicaid
FL1224140001Medicare NSC
FL65421BMedicare PIN
FLU61797Medicare UPIN
FL390287100Medicaid