Healthcare Provider Details

I. General information

NPI: 1972575215
Provider Name (Legal Business Name): ZULFIQAR A FAZAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 SW 1ST AVE
OCALA FL
34471
US

IV. Provider business mailing address

1623 SW 1ST AVE
OCALA FL
34471
US

V. Phone/Fax

Practice location:
  • Phone: 352-341-4778
  • Fax: 352-341-4477
Mailing address:
  • Phone: 352-732-9844
  • Fax: 352-351-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME78743
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME78743
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: