MEDICARE: FAROUQ A AL-HAMDAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	41123	WI
2	207XS0117X	Orthopaedic Surgery of the Spine Physician	MD 00036974	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0-456-828-3	OTHER		ECFMG
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003904434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAROUQ A AL-HAMDAN MD

Provider Business Mailing Address
First Line	:	119 S 14TH ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4114
Country	:	US
Telephone Number	:	713-553-3944
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 S 14TH ST
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98274-4114
Country	:	US
Telephone Number	:	713-553-3944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	03/07/2023

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