MEDICARE: TARIG GAFAR FADL 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	207R00000X	Internal Medicine Physician	30065	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1780616813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARIG GAFAR FADL MD

Provider Business Mailing Address
First Line	:	PO BOX 32950
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85064
Country	:	US
Telephone Number	:	602-433-1822
Fax Number	:	602-246-7060

Provider Business Practice Location Address
First Line	:	1804 W ELLIOT ROAD
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284
Country	:	US
Telephone Number	:	480-456-0444
Fax Number	:	480-456-0449

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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