Provider Demographics
NPI:1326416413
Name:EDWARD H. FARRIOR, MD, PA
Entity type:Organization
Organization Name:EDWARD H. FARRIOR, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:FARRIOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-875-3223
Mailing Address - Street 1:2908 W AZEELE ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3110
Mailing Address - Country:US
Mailing Address - Phone:813-875-3223
Mailing Address - Fax:813-875-5586
Practice Address - Street 1:2908 W AZEELE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3110
Practice Address - Country:US
Practice Address - Phone:813-875-3223
Practice Address - Fax:813-875-5586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50318207YX0007X
FLME1233642086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty