Provider Demographics
NPI:1053340521
Name:FAIG, DOUGLAS E (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:FAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5700 N FEDERAL HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2600
Mailing Address - Country:US
Mailing Address - Phone:954-776-1800
Mailing Address - Fax:954-776-3647
Practice Address - Street 1:5700 N FEDERAL HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2600
Practice Address - Country:US
Practice Address - Phone:954-776-1800
Practice Address - Fax:954-776-3647
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0039753207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049159400Medicaid
FL94015ZMedicare PIN
FLD64661Medicare UPIN