Healthcare Provider Details

I. General information

NPI: 1073562229
Provider Name (Legal Business Name): FARRUKH IQBAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FARRUKH IQBAL MD,FACE,FRCP

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N GREEN VALLEY PKWY
HENDERSON NV
89074-6391
US

IV. Provider business mailing address

1816 HAVERCAMP ST
LAS VEGAS NV
89117-6957
US

V. Phone/Fax

Practice location:
  • Phone: 702-450-5002
  • Fax: 702-837-8120
Mailing address:
  • Phone: 702-450-5002
  • Fax: 702-837-8120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number9181
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: