MEDICARE: DR. OMER FAROOQ 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	L4933	TX
2	207R00000X	Internal Medicine Physician	MD447278	PA
3	207R00000X	Internal Medicine Physician	25MA09197200	NJ
4	207R00000X	Internal Medicine Physician	MD 35163	SC

General Provider Information

NPI Number	:	1952333262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMER FAROOQ M.D.

Provider Business Mailing Address
First Line	:	8117 PRESTON RD
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75225-6332
Country	:	US
Telephone Number	:	214-368-9600
Fax Number	:	214-764-5650

Provider Business Practice Location Address
First Line	:	2525 E CAMELBACK RD
Second Line	:	SUITE 1100
City	:	PHOENIX
State	:	AZ
Zip	:	85016-4219
Country	:	US
Telephone Number	:	602-778-3600
Fax Number	:	602-778-3659

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/22/2013

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