Healthcare Provider Details

I. General information

NPI: 1760531479
Provider Name (Legal Business Name): FAROUK A. RAQUIB, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BOB LAWRENCE DRIVE
WINFIELD AL
35594-5120
US

IV. Provider business mailing address

125 BOB LAWRENCE DR
WINFIELD AL
35594-0019
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number16185
License Number StateAL

VIII. Authorized Official

Name: FAROUK RAQUIB
Title or Position: MD/ OWNER
Credential:
Phone: 205-487-4535