Individual
DR. MOHAMMAD FAROOQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
10175 FORTUNE PKWY, SUITE #1106, JACKSONVILLE, FL 32256-6746
(904) 379-5928
(904) 379-5967
Mailing address
10175 FORTUNE PKWY, SUITE #1106, JACKSONVILLE, FL 32256-6746
(904) 379-5928
(904) 379-5967
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME100550
FL
390200000X
Student in an Organized Health Care Education/Training Program
2005013889
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011903-00
—
FL
01
—
1455P
BCBS
FL
05
—
565587892A
—
GA
Enumeration date
07/21/2006
Last updated
03/18/2014
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