Provider Demographics
NPI:1093736985
Name:DOCTOR IS IN, PA
Entity Type:Organization
Organization Name:DOCTOR IS IN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-455-1234
Mailing Address - Street 1:4812 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5669
Mailing Address - Country:US
Mailing Address - Phone:903-455-1234
Mailing Address - Fax:903-455-2122
Practice Address - Street 1:4812 ROBERTS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5669
Practice Address - Country:US
Practice Address - Phone:903-455-1234
Practice Address - Fax:903-455-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189004801Medicaid
TX189004801Medicaid