Provider Demographics
NPI:1003956285
Name:ALI, FAZAL AKBAR (MD)
Entity Type:Individual
Prefix:
First Name:FAZAL
Middle Name:AKBAR
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4221 S WESTERN AVE STE 5020
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3445
Mailing Address - Country:US
Mailing Address - Phone:405-644-5428
Mailing Address - Fax:405-644-5429
Practice Address - Street 1:4221 S WESTERN AVE
Practice Address - Street 2:SUITE 5020
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3447
Practice Address - Country:US
Practice Address - Phone:405-644-5428
Practice Address - Fax:405-644-5429
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK24129207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology