MEDICARE: FARMINGTON FAMILY MEDICAL LLC

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	207Q00000X	Family Medicine Physician	E3510	AR

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	:	1952316390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FARMINGTON FAMILY MEDICAL LLC

Provider Business Mailing Address
First Line	:	199 E MAIN ST
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-3077
Country	:	US
Telephone Number	:	479-267-1001
Fax Number	:	479-267-1026

Provider Business Practice Location Address
First Line	:	199 E MAIN ST
Second Line	:
City	:	FARMINGTON
State	:	AR
Zip	:	72730-3077
Country	:	US
Telephone Number	:	479-267-1001
Fax Number	:	479-267-1026

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMAL ZIAD ABDIN
Credential	:	M.D.
Telephone Number	:	479-267-1001

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	02/10/2010

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