Healthcare Provider Details

I. General information

NPI: 1154370179
Provider Name (Legal Business Name): HASSAN FAROOQ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4812 ROBERTS ST
GREENVILLE TX
75401-5669
US

IV. Provider business mailing address

4812 ROBERTS ST
GREENVILLE TX
75401-5669
US

V. Phone/Fax

Practice location:
  • Phone: 903-455-1234
  • Fax: 903-455-2122
Mailing address:
  • Phone: 903-455-1234
  • Fax: 903-455-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK4421
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: