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Individual

EHTERAM RAISSI-FARD

Active
Sole proprietor

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
758 N SUN DR, LAKE MARY, FL 32746-2599
(407) 333-2809
(407) 333-2870
Mailing address
758 N SUN DR, LAKE MARY, FL 32746-2599
(407) 333-2809
(407) 333-2870

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME78139
FL

Other

Enumeration date
09/23/2005
Last updated
07/08/2007
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