Healthcare Provider Details

I. General information

NPI: 1417928656
Provider Name (Legal Business Name): FATEN ANWAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR DPT OF PATHOLOGY
FORT SAM HOUSTON TX
78234-4501
US

IV. Provider business mailing address

184 ARTILLERY POST RD
FORT SAM HOUSTON TX
78234-2626
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-7234
  • Fax:
Mailing address:
  • Phone: 210-916-7237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZI0100X
TaxonomyImmunopathology Physician
License NumberMD00036692
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: