Provider Demographics
NPI:1467408021
Name:ANWAR, SARFARAZ (MD)
Entity Type:Individual
Prefix:
First Name:SARFARAZ
Middle Name:
Last Name:ANWAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SARFARAZ
Other - Middle Name:
Other - Last Name:ANWAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1605 NW 171ST ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-7415
Mailing Address - Country:US
Mailing Address - Phone:580-210-0040
Mailing Address - Fax:405-330-9082
Practice Address - Street 1:1605 NW 171ST ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-7415
Practice Address - Country:US
Practice Address - Phone:580-210-0040
Practice Address - Fax:405-330-9082
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2015-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100008280BMedicaid
OKG39067Medicare UPIN
OK249341021Medicare ID - Type Unspecified