Healthcare Provider Details

I. General information

NPI: 1194760918
Provider Name (Legal Business Name): FAHED M HAMADEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 10/19/2020
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13401 N WESTERN AVE SUITE 210
OKLAHOMA CITY OK
73114-1408
US

IV. Provider business mailing address

PO BOX 269064
OKLAHOMA CITY OK
73126-9064
US

V. Phone/Fax

Practice location:
  • Phone: 405-272-4953
  • Fax: 405-272-4956
Mailing address:
  • Phone: 405-231-3857
  • Fax: 405-272-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK1461
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number26035
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: