Healthcare Provider Details

I. General information

NPI: 1518196930
Provider Name (Legal Business Name): IMRAN FAYAZ, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDICAL CENTER BLVD STE 222
CONROE TX
77304-2800
US

IV. Provider business mailing address

PO BOX 131479
THE WOODLANDS TX
77393-1479
US

V. Phone/Fax

Practice location:
  • Phone: 281-779-4030
  • Fax: 281-419-9997
Mailing address:
  • Phone: 281-779-4030
  • Fax: 281-419-9997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberM1090
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM1090
License Number StateTX

VIII. Authorized Official

Name: DR. IMRAN FAYAZ
Title or Position: OWNER & PRESIDENT
Credential: M.D.
Phone: 281-779-4030