Healthcare Provider Details

I. General information

NPI: 1710297940
Provider Name (Legal Business Name): FARAH NAZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2459 E HEBRON PKWY SUITE 100
CARROLLTON TX
75010-4482
US

IV. Provider business mailing address

2459 E HEBRON PKWY SUITE 100
CARROLLTON TX
75010-4482
US

V. Phone/Fax

Practice location:
  • Phone: 972-395-8600
  • Fax: 972-395-7119
Mailing address:
  • Phone: 972-395-8600
  • Fax: 972-395-7119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL0446
License Number StateTX

VIII. Authorized Official

Name: DR. FARAH NAZ
Title or Position: OWNER
Credential: MD
Phone: 972-395-8600