Basic Information
| Provider Information | |||||||||
| NPI: | 1508962523 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FARID GHEBLEH MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2525 W BERYL AVE | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850211606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024247967 | ||||||||
| FaxNumber: | 6023714960 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 W CHANDLER BLVD | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852246141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6025945400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| AuthorizedOfficialLastName: | GHEBLEH | ||||||||
| AuthorizedOfficialFirstName: | FARID | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6029090909 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 15863 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.