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General NPI Number Information
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NPI Number | 1518196930
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Entity Type | Organization
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Legal Business Name | IMRAN FAYAZ, M.D., P.A.
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 500 MEDICAL CENTER BLVD STE 222
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City | CONROE
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State | TX
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Zip | 77304-2800
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Country | US
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Telephone | 281-779-4030
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Fax | 281-419-9997
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Provider Business Mailing Address
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Address Line | PO BOX 131479
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City | THE WOODLANDS
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State | TX
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Zip | 77393-1479
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Country | US
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Telephone | 281-779-4030
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Fax | 281-419-9997
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Authorized Official
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Title or Position | OWNER & PRESIDENT
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Name | DR. IMRAN FAYAZ
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Credential | M.D.
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Telephone | 281-779-4030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M1090
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | M1090
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License Number State | TX
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