Provider Demographics
NPI:1275065559
Name:FARHAN, MUHAMMAD LATIF (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:LATIF
Last Name:FARHAN
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 1:501 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-2401
Mailing Address - Country:US
Mailing Address - Phone:267-575-2749
Mailing Address - Fax:
Practice Address - Street 1:1631 11TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4332
Practice Address - Country:US
Practice Address - Phone:940-263-3000
Practice Address - Fax:940-263-3018
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5613207R00000X
PAMT212860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine