Basic Information
| Provider Information | |||||||||
| NPI: | 1720271703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHANJI | ||||||||
| FirstName: | SARFARAZ | ||||||||
| MiddleName: | SHIRAZ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 45443 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841450443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042021032 | ||||||||
| FaxNumber: | 9043764107 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 BEACH BLVD | ||||||||
| Address2: | CREDENTIALING DEPARTMENT | ||||||||
| City: | JACKSONVILLE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322504368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042490335 | ||||||||
| FaxNumber: | 9042490042 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2007 | ||||||||
| LastUpdateDate: | 12/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME116835 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 062330 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010774400 | 05 | FL | MEDICAID | 634995923A | 05 | GA | MEDICAID | P01381657 | 01 | FL | RAILROAD MEDICARE | OTHER | P00725400 | 01 | GA | RR MEDICARE | OTHER |