Provider Demographics
NPI:1316392004
Name:OMER FAROOQ MD PLLC
Entity Type:Organization
Organization Name:OMER FAROOQ MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OMER
Authorized Official - Middle Name:
Authorized Official - Last Name:FAROOQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-300-2161
Mailing Address - Street 1:5542 MANGROVE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-3769
Mailing Address - Country:US
Mailing Address - Phone:281-300-2161
Mailing Address - Fax:
Practice Address - Street 1:5542 MANGROVE CREEK LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-3769
Practice Address - Country:US
Practice Address - Phone:281-300-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-29
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty