MEDICARE: DR. IMRAN FAYAZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	M1090	TX

General Provider Information

NPI Number	:	1396717351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IMRAN FAYAZ M.D.

Provider Business Mailing Address
First Line	:	PO BOX 131479
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77393-1479
Country	:	US
Telephone Number	:	281-779-4030
Fax Number	:	281-419-9997

Provider Business Practice Location Address
First Line	:	500 MEDICAL CENTER BLVD STE 222
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2800
Country	:	US
Telephone Number	:	281-880-0700
Fax Number	:	281-419-9997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	06/15/2023

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