Individual
DR. AUDREY ESHRAT FARAHMAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14090 METROPOLIS AVE, SUITE #102, FORT MYERS, FL 33912
(239) 332-2388
(239) 332-2382
Mailing address
11600 COURT OF PALMS, UNIT #605, FORT MYERS, FL 33908-6545
(239) 332-2388
(239) 332-2382
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
ME89962
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-2539348
TAX ID
FL
01
—
48097
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/23/2006
Last updated
12/23/2011
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