Provider Demographics
NPI:1477511194
Name:RAQUIB, FAROUK ANWARUL (MD)
Entity Type:Individual
Prefix:DR
First Name:FAROUK
Middle Name:ANWARUL
Last Name:RAQUIB
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:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-1140
Mailing Address - Country:US
Mailing Address - Phone:205-487-4535
Mailing Address - Fax:205-487-8827
Practice Address - Street 1:125 BOB LAWRENCE DRIVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:AL
Practice Address - Zip Code:35594
Practice Address - Country:US
Practice Address - Phone:205-487-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16185207P00000X
ALMD.16185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051553562Medicaid
AL051556262RAQMedicare ID - Type Unspecified
AL6372860001Medicare NSC
ALF09363Medicare UPIN