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General NPI Number Information
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NPI Number | 1205499175
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Entity Type | Organization
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Legal Business Name | FAZAL AND ASSOCIATES PLLC
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Dates
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Enumeration Date | 04/17/2019
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Last Update Date | 04/17/2019
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Provider Practice Location Address
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Address Line | 255 CHURCH ST STE 100
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City | PIKEVILLE
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State | KY
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Zip | 41501-3499
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Country | US
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Telephone | 606-791-6115
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Fax |
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Provider Business Mailing Address
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Address Line | 150 FALCON CREST CT
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City | HAZARD
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State | KY
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Zip | 41701-1432
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Country | US
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Telephone | 606-791-6115
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | FARHAN FAZAL
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Credential | MD
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Telephone | 606-791-6115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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