Basic Information
Provider Information | |||||||||
NPI: | 1952333262 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FAROOQ | ||||||||
FirstName: | OMER | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8117 PRESTON RD | ||||||||
Address2: | SUITE 800 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752256332 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2143689600 | ||||||||
FaxNumber: | 2147645650 | ||||||||
Practice Location | |||||||||
Address1: | 2525 E CAMELBACK RD | ||||||||
Address2: | SUITE 1100 | ||||||||
City: | PHOENIX | ||||||||
State: | AZ | ||||||||
PostalCode: | 850164219 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6027783600 | ||||||||
FaxNumber: | 6027783659 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/07/2006 | ||||||||
LastUpdateDate: | 04/22/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | L4933 | TX | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | MD447278 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 25MA09197200 | NJ | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | MD 35163 | SC | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.