Healthcare Provider Details

I. General information

NPI: 1952541690
Provider Name (Legal Business Name): SARDAR MOHAMMAD FARHAN KHAN GALZIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 01/01/2021
Certification Date: 01/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST STE 5000
OKLAHOMA CITY OK
73102-1018
US

IV. Provider business mailing address

608 NW 9TH ST STE 5000
OKLAHOMA CITY OK
73102-1018
US

V. Phone/Fax

Practice location:
  • Phone: 405-772-4533
  • Fax: 405-772-4539
Mailing address:
  • Phone: 405-772-4533
  • Fax: 405-772-4539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number12441
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA105404
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number33438
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: