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NPI Code Detail

MEDICARE: DR. IFTIKHAR FAZAL HAQ D.O.

MEDICARE: DR. IFTIKHAR FAZAL HAQ D.O.
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
1207Q00000XFamily Medicine PhysicianOS6099FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
180804OTHERFLBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902899958
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IFTIKHAR FAZAL HAQ D.O.
Provider Business Mailing Address
First Line : 120 VINTAGE LN
Second Line :
City : PALATKA
State : FL
Zip : 32177-8555
Country : US
Telephone Number : 386-325-5801
Fax Number : 386-325-4777
Provider Business Practice Location Address
First Line : 100 COMMERCIAL DR
Second Line :
City : KEYSTONE HEIGHTS
State : FL
Zip : 32656-6802
Country : US
Telephone Number : 352-473-6595
Fax Number : 352-473-6597
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2005
Last Update Date : 12/18/2019

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