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NPI Code Detail

MEDICARE: FAWAD H WALAJAHI M.D.

MEDICARE: FAWAD H WALAJAHI M.D.
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
1207L00000XAnesthesiology PhysicianR3423AR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2050019322OTHERRAILROAD MEDICARE/PGBA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
155444OTHERARBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053316067
Entity Type Code : Individual
Provider Name (Legal Business Name) : FAWAD H WALAJAHI M.D.
Provider Business Mailing Address
First Line : PO BOX 1272
Second Line :
City : PINE BLUFF
State : AR
Zip : 71613-1272
Country : US
Telephone Number : 870-535-7457
Fax Number : 870-535-2522
Provider Business Practice Location Address
First Line : 1801 W 40TH AVE
Second Line : STE 2B
City : PINE BLUFF
State : AR
Zip : 71603-6957
Country : US
Telephone Number : 870-535-7457
Fax Number : 870-535-2522
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 06/24/2008

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Directions to “ FAWAD H WALAJAHI M.D.” Practice Location

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