Provider Demographics
NPI:1457458259
Name:NAZ, FARAH (MD)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:NAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2459 E HEBRON PKWY
Mailing Address - Street 2:100
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4482
Mailing Address - Country:US
Mailing Address - Phone:972-395-8600
Mailing Address - Fax:972-395-7119
Practice Address - Street 1:2459 E HEBRON PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4482
Practice Address - Country:US
Practice Address - Phone:972-395-8600
Practice Address - Fax:972-395-7119
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL0446208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144528001Medicaid
G94197OtherUPIN
TX144528004OtherTX HEALTH STEPS
TX0060GXOtherBLUE CROSS BLUE SHIELD
TX144528004OtherTX HEALTH STEPS