Provider Demographics
NPI:1003904434
Name:AL-HAMDAN, FAROUQ A (MD)
Entity Type:Individual
Prefix:
First Name:FAROUQ
Middle Name:A
Last Name:AL-HAMDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4114
Mailing Address - Country:US
Mailing Address - Phone:713-553-3944
Mailing Address - Fax:
Practice Address - Street 1:119 S 14TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4114
Practice Address - Country:US
Practice Address - Phone:713-553-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41123207XS0117X
WAMD 00036974207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0-456-828-3OtherECFMG
WI34262200Medicaid
BA7912377OtherDEA #