Healthcare Provider Details

I. General information

NPI: 1821354598
Provider Name (Legal Business Name): FAROOK W TAHA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2012
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N GALLOWAY AVE
MESQUITE TX
75149-2433
US

IV. Provider business mailing address

3552 FLOWING WAY
PLANO TX
75074-9005
US

V. Phone/Fax

Practice location:
  • Phone: 214-320-7000
  • Fax:
Mailing address:
  • Phone: 845-518-4943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number270821
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ2072
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: