Provider Demographics
NPI:1346284593
Name:MAQBOOL, FAROOQ (MD)
Entity Type:Individual
Prefix:DR
First Name:FAROOQ
Middle Name:
Last Name:MAQBOOL
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 1:5404 NW 107TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-7005
Mailing Address - Country:US
Mailing Address - Phone:405-620-7220
Mailing Address - Fax:405-878-4690
Practice Address - Street 1:5404 NW 107TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-7005
Practice Address - Country:US
Practice Address - Phone:405-620-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOKA105837OtherMEDICARE PTAN
OK100114650AMedicaid
OK18403OtherOKLAHOMA STATE LICENSE
OKF91180Medicare UPIN
OK243600502Medicare ID - Type Unspecified