Basic Information
| Provider Information | |||||||||
| NPI: | 1871537209 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARIDAD | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2555 PONCE DE LEON BLVD | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331346010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3057025135 | ||||||||
| FaxNumber: | 3054412144 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331462008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863082301 | ||||||||
| FaxNumber: | 7863082344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 11/07/2014 | ||||||||
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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 | 2085R0204X | ME77101 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0202X | ME77101 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 285183 | 01 | FL | AVMED | OTHER | 256693100 | 05 | FL | MEDICAID | 46566 | 01 | FL | BCBS | OTHER | 300131767 | 01 | FL | RAILROAD MEDICARE | OTHER | 041309 | 01 | FL | NHP | OTHER |