Active NPI
Mohammad Ibrahim Fardos
- Dermatology Physician
- Port Richey, FL
National Provider Identifier
1104575588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 23826
- Practice address
- 8220 US Highway 19
Port Richey, FL 34668-6639 - Phone
- (727) 588-5704
- NPI assigned
- Mar 22, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 23826 | FL | Primary |
Addresses
Primary practice location
8220 US Highway 19
Port Richey, FL 34668-6639
Mailing address
8220 US Highway 19
Port Richey, FL 34668-6639
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23826 | FL | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780444800000",
"number": "1104575588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8220 US HIGHWAY 19",
"city": "PORT RICHEY",
"state": "FL",
"postal_code": "346686639"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8220 US HIGHWAY 19",
"city": "PORT RICHEY",
"state": "FL",
"postal_code": "346686639",
"telephone_number": "727-588-5704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FARDOS",
"first_name": "MOHAMMAD",
"middle_name": "IBRAHIM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-22",
"last_updated": "2026-06-03",
"certification_date": "2026-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "FL",
"license": "23826",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Richey, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.