Healthcare Provider Details

I. General information

NPI: 1093770737
Provider Name (Legal Business Name): SHERIF TAHA AL-FARRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 MONTGOMERY ST
FORT WORTH TX
76107-2553
US

IV. Provider business mailing address

PO BOX 99335
FORT WORTH TX
76199-0335
US

V. Phone/Fax

Practice location:
  • Phone: 817-735-2660
  • Fax: 817-735-5441
Mailing address:
  • Phone: 817-735-2660
  • Fax: 817-735-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberL4211
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberL4211
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: