Basic Information
| Provider Information | |||||||||
| NPI: | 1437104577 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARKAS | ||||||||
| FirstName: | JACQUES | ||||||||
| MiddleName: | NATHAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 521 W STATE ROAD 434 | ||||||||
| Address2: | STE 301 | ||||||||
| City: | LONGWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327505166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218417550 | ||||||||
| FaxNumber: | 3218418185 | ||||||||
| Practice Location | |||||||||
| Address1: | 89 W COPELAND DR | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328062002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218417550 | ||||||||
| FaxNumber: | 3218418185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 03/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME53374 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0127X | ME53374 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 207T00000X | ME53374 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 044749800 | 05 | FL | MEDICAID | ME53374 | 01 | FL | MEDICAL LICENSE | OTHER |