Provider Demographics
NPI:1467478636
Name:FAIZULLAH, ABULBASHER M (MD)
Entity Type:Individual
Prefix:
First Name:ABULBASHER
Middle Name:M
Last Name:FAIZULLAH
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 1:1816 N MIDLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-6407
Mailing Address - Country:US
Mailing Address - Phone:432-699-5111
Mailing Address - Fax:432-588-0773
Practice Address - Street 1:1816 N MIDLAND DR
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-6407
Practice Address - Country:US
Practice Address - Phone:432-699-5111
Practice Address - Fax:432-588-0773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG2695OtherLICENSE
TX00AG11OtherBCBS OF TEXAS
TX00AG11OtherBCBS OF TEXAS