Healthcare Provider Details

I. General information

NPI: 1205271210
Provider Name (Legal Business Name): FARZANA TARIQ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65212-3309
US

IV. Provider business mailing address

1 HOSPITAL DR
COLUMBIA MO
65212-4038
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-3957
  • Fax:
Mailing address:
  • Phone: 573-882-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number0101271396
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number2023033932
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: