Provider Demographics
NPI:1992746408
Name:GHEBLEH, FARID (MD)
Entity type:Individual
Prefix:
First Name:FARID
Middle Name:
Last Name:GHEBLEH
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 1:10645 N TATUM BLVD STE 200623
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3068
Mailing Address - Country:US
Mailing Address - Phone:602-909-0909
Mailing Address - Fax:602-371-4960
Practice Address - Street 1:8201 N 54TH ST
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-2522
Practice Address - Country:US
Practice Address - Phone:602-909-0909
Practice Address - Fax:623-535-0707
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15863207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ870261Medicaid
AZ273285Medicaid
71176Medicare ID - Type Unspecified