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General NPI Number Information
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NPI Number | 1881019537
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Entity Type | Organization
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Legal Business Name | SOUTH OTOLARYNGOLOGY-HEAD AND NECK SURGERY, LLC
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Dates
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Enumeration Date | 03/04/2014
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 2126 W ROY PARKER RD STE 207
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City | OZARK
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State | AL
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Zip | 36360-8566
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Country | US
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Telephone | 334-443-0335
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Fax |
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Provider Business Mailing Address
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Address Line | 2126 W ROY PARKER RD STE 207
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City | OZARK
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State | AL
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Zip | 36360-8566
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Country | US
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Telephone | 334-443-0335
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/PHYSICIAN
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Name | DR. TARIK Y FARRAG
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Credential | MD
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Telephone | 443-854-6019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | MD.32237
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License Number State | AL
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