Provider Demographics
NPI:1962423103
Name:OSMAN, FARID (MD)
Entity type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:OSMAN
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 1:108 LYNCH CREEK WAY
Mailing Address - Street 2:SUITE
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2357
Mailing Address - Country:US
Mailing Address - Phone:707-765-3343
Mailing Address - Fax:707-765-3340
Practice Address - Street 1:108 LYNCH CREEK WAY
Practice Address - Street 2:SUITE
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2357
Practice Address - Country:US
Practice Address - Phone:707-765-3343
Practice Address - Fax:707-765-3340
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-85207RN0300X
TXL4618207RN0300X
CAA85616207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR988YMedicare PIN