Healthcare Provider Details

I. General information

NPI: 1477511194
Provider Name (Legal Business Name): FAROUK ANWARUL RAQUIB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BOB LAWRENCE DRIVE
WINFIELD AL
35594
US

IV. Provider business mailing address

PO BOX 1140
WINFIELD AL
35594-1140
US

V. Phone/Fax

Practice location:
  • Phone: 205-487-4535
  • Fax:
Mailing address:
  • Phone: 205-487-4535
  • Fax: 205-487-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number16185
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.16185
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: