MEDICARE: FARHAN RAZA

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1699215566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARHAN RAZA

Provider Business Mailing Address
First Line	:	1100 WILFORD HALL LOOP, BLDG. 4554
Second Line	:
City	:	JBSA LACKLAND
State	:	TX
Zip	:	78236-9908
Country	:	US
Telephone Number	:	210-228-6383
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 WILFORD HALL LOOP, BLDG. 4554
Second Line	:
City	:	JBSA LACKLAND AFB
State	:	TX
Zip	:	78236-9908
Country	:	US
Telephone Number	:	210-228-6383
Fax Number	:

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

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	04/23/2018

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Directions to “ FARHAN RAZA ” Practice Location

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