Individual
BASANT M FARGHALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3100 US HIGHWAY 1 S STE 4, ST AUGUSTINE, FL 32086-6310
(904) 810-8063
(904) 621-9230
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
(904) 810-8063
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME97900
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
278175100
—
FL
01
—
PW879
MEDICARE HF
FL
Enumeration date
03/27/2007
Last updated
10/04/2022
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