Joseph Fanfan Jr., M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME43065 Issued in FL

Practice address

2630N Andrews Ave
Wilton Manors, FL 33311-2550

Phone

(954) 525-4900

Fax

(954) 396-3110

NPI assigned

May 6, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• La Clinique 300 Inc

  • Clinic/Center
  • Wilton Manors, FL
  • NPI 1689059453
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1210032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439164800000",
    "number": "1265608616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2630N ANDREWS AVE",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333112550",
            "telephone_number": "954-525-4900",
            "fax_number": "954-396-3110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630N ANDREWS AVE",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333112550",
            "telephone_number": "954-525-4900",
            "fax_number": "954-396-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANFAN",
        "first_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-06",
        "last_updated": "2015-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME43065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "068166100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie J Elsbree, L.C.S.W., C.A.P.
• Wilna Eugene
• Misty Dawn Evans, MSW
• Rosenie Ezai-Gilles
• Patricia Falco, LMHC
• David Farin, LMT
• Michael Andrew Farris, PSY.D.
• Felice Fusca LCSW LLC
• Ferdinand Cabrera MD PA
• Arielvys Fernandez Febles, RDH

• Family Medicine Physician in Wilton Manors, FL
• Providers in Wilton Manors, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; 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.

Verify at the official NPI Registry.