MEDICARE: AZHAR AFAQ 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	207R00000X	Internal Medicine Physician	21523	OK
2	207R00000X	Internal Medicine Physician	L0967	TX
3	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	L0967	TX

General Provider Information

NPI Number	:	1518906569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AZHAR AFAQ M.D.

Provider Business Mailing Address
First Line	:	3659 CROWBERRY WAY
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76040-7174
Country	:	US
Telephone Number	:	405-602-5169
Fax Number	:

Provider Business Practice Location Address
First Line	:	1617 HEMPHILL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4709
Country	:	US
Telephone Number	:	817-927-3941
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	06/24/2016

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